Metal stent for the ureteral stricture after surgery and/or radiation treatment for malignancy

Abstract Background To assess the efficacy and safety of self-expanding metal ureteral stent for the stricture following surgery and/or radiation for malignancy. Methods We performed 36 metal ureteral stent insertion procedures (32 patients) between May 2019 and June 2020. The main inclusion criterion was the patients with ureteral stricture due to surgery and/or radiation treatment for malignancy. The diagnosis of stricture was ascertained by history and radiographic imaging. The etiologies underlying the strictures were: surgery and/or radiation therapy for cervical and rectal cancer, surgery for ovarian cancer. The primary outcome was the stent patency rate, and the secondary outcomes were the postoperative complications and glomerular filtration rate (GFR). Stent patency was defined as stent in situ without evident migration, unanticipated stent exchange or recurrent ureteral obstruction. Cost analysis was calculated from stent cost, anesthesia cost and operating room fee. Results The pre-metallic stent GFR was 22.53 ± 6.55 mL/min/1.73 m2. Eight patients were on double-J stents before insertion of metallic stents. The total annual cost of per patient in our study was $10,600.2 US dollars (range $9394.4–$33,527.4 US dollars). During a median follow-up time of 16 months (range 8–21 months), 27 cases (31 sides, 84%) remained stent patency. Twelve patients died from their primary malignancy carrying a patency stent. Stent migration was observed in 4 patients within 10 months after insertion. Ectopic stents were endoscopically removed and replaced successfully. Three stents were occluded, and no encrustation was seen in our study. Three and four patients had postoperative fever and gross hematuria, respectively. Infection was observed in 2 cases, mandating antibiotics therapy. In addition, postoperative volume of hydronephrosis postoperatively was significantly reduced compared with preoperation (54.18 ± 15.42 vs 23.92 ± 8.3, P = 0.019). However, no statistically significant differences regarding GFR, creatinine levels, blood urea nitrogen and hemoglobin existed between preoperation and last follow-up. Conclusions The current study demonstrated that metal ureteral stent is effective and safe in the treatment of stricture following surgery and/or radiation therapy for malignant cancer. Patients hydronephrosis could be improved by the stent placement.

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The resonance® metallic ureteral stent in the treatment of malignant ureteral obstruction: a prospective observational study

BMC Urology ◽

10.1186/s12894-019-0569-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Jun Miyazaki ◽

Mizuki Onozawa ◽

Satoshi Takahashi ◽

Yuka Maekawa ◽

Mitsuru Yasuda ◽

...

Keyword(s):

Ureteral Obstruction ◽

Ureteral Stent ◽

Stent Insertion ◽

Ureteral Stricture ◽

Metallic Stent ◽

Ureteric Stenting ◽

Malignant Ureteral Obstruction ◽

Ureteral Stenting ◽

The Difference

Abstract Background To study the outcomes and experiences of using metallic stents in treating patients with malignant ureteral obstruction (MUO), we examined the effects of metallic ureteral stenting using the Cook Resonance® stent in the treatment of MUO. Methods All patients who had a Resonance metallic stent inserted between April 2015 and March 2018 at one of multiple facilities were prospectively observed with a 1-year follow-up. The primary outcome was the patency rate of the metallic ureteral stent. The secondary outcomes included the complications (e.g., infection and fever). Results Although stent insertion was attempted in 50 patients, the stent could not be inserted as a ureteral stent in three patients due to severe ureteral stricture, and one ureteral cancer patient was excluded from the analysis. The remaining 46 patients’ median age was 67 years (range 28–85 years) (16 males, 30 females). Twenty-four patients died during the study; their median survival time was 226 days. The median follow-up period for the censored patients was 355 days (range 16–372 days), and just seven patients were still alive without Resonance failure > 1 year later. The women’s IPSS scores tended to be lower than those of the men. Regarding the OABSS score, although the women’s total score tended to be low, the difference between the men’s and women’s scores was nonsignificant. The bacteria detected from urine culture after stent insertion were more gram-positive than gram-negative. Conclusion Metallic ureteric stenting using the Resonance stent is safe and effective for treating MUO. Subjective symptoms were relatively less in the female patients.

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Flap Reconstruction of Sarcoma Defects in the Setting of Neoadjuvant and Adjuvant Radiation

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1675147 ◽

2018 ◽

Vol 35 (04) ◽

pp. 287-293 ◽

Cited By ~ 1

Author(s):

Rohini Kadle ◽

Catherine Motosko ◽

George Zakhem ◽

John Stranix ◽

Timothy Rapp ◽

...

Keyword(s):

Radiation Therapy ◽

Soft Tissue ◽

Radiation Treatment ◽

Soft Tissue Sarcomas ◽

Adjuvant Radiation ◽

Complication Rates ◽

Flap Reconstruction ◽

Fasciocutaneous Flaps ◽

Musculoskeletal Tumor Society

Background Limb-sparing treatment of extremity soft tissue sarcomas requires wide resections and radiation therapy. The resulting complex composite defects necessitate reconstructions using either muscle or fasciocutaneous flaps, often in irradiated wound beds. Methods A retrospective chart review was performed of all limb-sparing soft tissue sarcoma resections requiring immediate flap reconstruction from 2012 through 2016. Results Forty-four patients with 51 flaps were identified: 25 fasciocutaneous and 26 muscle-based flaps. Mean defect size, radiation treatment, and follow-up length were similar between groups. More often, muscle-based flaps were performed in younger patients and in the lower extremity. Seventeen flaps were exposed to neoadjuvant radiation, 12 to adjuvant radiation, 5 to both, and 17 to no radiation therapy. Regardless of radiation treatment, complication rates were comparable, with 28% in fasciocutaneous and 31% in muscle-based groups (p < 0.775). Muscle-based flaps performed within 6 weeks of undergoing radiotherapy were less likely to result in complications than those performed after greater than 6 weeks (p < 0.048). At time of follow-up, Musculoskeletal Tumor Society scores for fasciocutaneous and muscle-based reconstructions, with or without radiation, showed no significant differences between groups (mean [SD]: 91% [8%] vs. 89% [13%]). Conclusion The similar complication rates and functional outcomes in this study support the safety and efficacy of both fasciocutaneous flaps and muscle-based flaps in reconstructing limb-sparing sarcoma resection defects, with or without radiotherapy.

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Fractures of self-expanding metallic stents in periampullary malignant biliary obstruction

Acta Radiologica ◽

10.1080/02841850903039763 ◽

2009 ◽

Vol 50 (7) ◽

pp. 730-737 ◽

Cited By ~ 13

Author(s):

I. C. Rasmussen ◽

U. Dahlstrand ◽

G. Sandblom ◽

L. G. Eriksson ◽

R. Nyman

Keyword(s):

Biliary Obstruction ◽

Malignant Biliary Obstruction ◽

Metallic Stents ◽

Biliary Duct ◽

Stent Insertion ◽

Stent Fracture ◽

Metallic Stent ◽

Stent Patency ◽

Life Threatening ◽

The Mean

Background: Self-expanding metallic stents are widely used for relieving biliary duct obstruction in patients with unresectable periampullary malignancies. However, only a few studies have assessed the occurrence of fractures in these stents. Purpose: To determine the prevalence and significance of stent fracture after placement of self-expanding metallic stents for periampullary malignant biliary obstruction. Material and Methods: Over a 5-year period, 48 patients underwent placement of self-expanding metallic stents for periampullary malignant biliary obstructions. Stents were introduced 2–6 weeks after a percutaneous transhepatic biliary decompression. The medical records and relevant images were reviewed for stent patency, stent fracture, type of stent, and stent-related complications. Results: Stent fracture was detected in four of the 48 patients (8%): in one patient at 1 month and in three patients between 10 and 21 months after stenting. All four fractures involved one type of nitinol stent used in 38 patients. In one of the patients, fracture was complicated by life-threatening gastrointestinal bleeding. The mean survival time for all patients was 251 days (standard deviation [SD]±275 days) and the mean overall patency time for all stents was 187 days (SD±205 days). Conclusion: Stent fracture occurs after placement of self-expanding nitinol stents for periampullary malignant biliary obstruction. The low reported incidence of this complication may be due to a lack of awareness of and difficulty in detecting stent fracture. Fracture should be considered as a possible contributing factor in recurrent biliary obstruction after self-expanding metallic stent insertion.

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Radiation therapy of laryngeal cancer: A twenty year experience

The Journal of Laryngology & Otology ◽

10.1017/s0022215100113660 ◽

1990 ◽

Vol 104 (9) ◽

pp. 699-703 ◽

Cited By ~ 11

Author(s):

N. L. K. Robson ◽

V. H. Oswal ◽

L. M. Flood

Keyword(s):

Radiation Therapy ◽

Laryngeal Cancer ◽

Squamous Cell ◽

Clinical Evidence ◽

Radiation Treatment ◽

Nodal Metastasis ◽

Squamous Cell Carcinomas ◽

Primary Disease ◽

Primary Radiotherapy

AbstractThis paper reviews a 20 year experience of radiation treatment of 286 laryngeal cancers and presents results with a minimum five year follow-up. All cases presented had glottic or supraglottic squamous cell carcinomas with no clinical evidence of nodal metastasis. A policy of primary radiotherapy, with surgery for salvage of treatment failures, produced control of primary disease and prevention of metastases superior to most other regimes documented in the literature.

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Neuro-ophthalmological assessment of vision before and after radiation therapy alone for pituitary macroadenomas

Journal of Neurosurgery ◽

10.3171/jns.1990.72.4.0594 ◽

1990 ◽

Vol 72 (4) ◽

pp. 594-599 ◽

Cited By ~ 14

Author(s):

Stephen C. Rush ◽

Mark J. Kupersmith ◽

Irving Lerch ◽

Paul Cooper ◽

Joseph Ransohoff ◽

...

Keyword(s):

Visual Acuity ◽

Radiation Therapy ◽

Visual Field ◽

Visual Impairment ◽

Optic Atrophy ◽

Radiation Treatment ◽

Visual Field Defects ◽

Content Type ◽

Pituitary Macroadenomas

✓ Between 1972 and 1988, 25 patients were treated by radiation therapy (RT) alone for pituitary macroadenomas causing visual impairment. Twenty-three patients were evaluated by a neuro-ophthalmologist before treatment and at the time of follow-up review. Radiation treatment consisted of 4000 to 5000 cGy over 4 to 5 weeks. The median follow-up period was 36 months (range 2 to 192 months). Eighteen patients (78%) experienced visual field improvement. Deterioration occurred in four patients due to tumor recurrence, tumor hemorrhage, possible optic nerve necrosis, and optic chiasm herniation. Visual field improvement occurred predominantly in patients whose pretreatment visual field defects were less than a dense hemianopsia, who did not have diffuse optic atrophy, and who were younger than the median age of 69 years (p < 0.001). Visual acuity improvement occurred in patients without diffuse optic atrophy, with only mild impairment of the visual acuity, and with only mild visual field loss prior to RT (p < 0.002). It is concluded that there is a subset of patients with pituitary macroadenomas and visual impairment for whom primary RT is a treatment option.

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Percutaneous Biliary Metallic Stent Insertion in Patients with Malignant Duodenobiliary Obstruction: Outcomes and Factors Influencing Biliary Stent Patency

Korean Journal of Radiology ◽

10.3348/kjr.2019.0753 ◽

2020 ◽

Vol 21 (6) ◽

pp. 695

Author(s):

Ji Hye Kwon ◽

Dong Il Gwon ◽

Jong Woo Kim ◽

Hee Ho Chu ◽

Jin Hyoung Kim ◽

...

Keyword(s):

Biliary Stent ◽

Stent Insertion ◽

Metallic Stent ◽

Stent Patency ◽

Factors Influencing

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Retrograde ureteric stent insertion from percutaneous suprapubic access to the bladder in renal transplant recipients with ureteric stenosis: a novel minimally invasive technique

BMC Urology ◽

10.1186/s12894-020-00748-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jian-Hui Wu ◽

Chun-Bai Mo ◽

Li Dong-Zhai ◽

Fei Luo ◽

Qing-Tong Ma ◽

...

Keyword(s):

Case Series ◽

Complete Recovery ◽

Percutaneous Nephrostomy ◽

Ureteral Stent ◽

Invasive Technique ◽

Stent Insertion ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Ureteric Stent

Abstract Background Ureteric stricture is a common and salvaging complications after renal transplantation. Two treatment methods are usually used, retrograde ureteral stent placement and percutaneous nephrostomy. The former has a higher failure rate, the latter has a great risk. Therefore, a safe and reliable treatment is needed. Case presentation A technique of retrograde insertion of ureteral stent was established, which was applicable in three transplant recipients with post-transplant ureteral stenosis, and the data was retrospectively recorded. The patients are 2 men and 1 woman, ages 44, 27 and 32 years. These patients underwent a total of five times of retrograde insertion of ureteral stent between 2018 and 2019. None of these patients had any postoperative complication, but all patients had complete recovery from oliguric status within two weeks. Conclusions The retrograde ureteric stent insertion by percutaneous suprapubic access to the bladder (RUS-PSAB) was demonstrated feasibility and safety in a case series with short-term follow-up. However, larger prospective studies are needed.

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Concomitant chemoradiotherapy in women with stage II-III breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e11501 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e11501-e11501

Author(s):

Eduardo arnoldo Richardet ◽

Perelli Laura ◽

Martin Eduardo Richardet ◽

Nicolas Castagneris ◽

Matias Nicolas Cortes ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Medical Records ◽

Hormone Receptors ◽

Radiation Treatment ◽

Conservative Surgery ◽

Concomitant Chemoradiotherapy ◽

Standardized Treatment ◽

Grade 3

e11501 Background: To demonstrate the compliance of radiotherapy and chemotherapy with concomitant taxanes by avoiding delays initiation of that treatment Methods: Retrospective, observational, and descriptive. We analyzed the medical records of 50 patients from June 2006 to December 2010 with an average follow up of 27.26 months (9 months to 56 months), in which all completed conservative surgery. The chemotherapy used was AC x 4 cycles (doxorubicin 60 mg/m2, Cyclophosphamide 600 mg/m2 on day 1 every 21 days) followed by weekly paclitaxel 80 mg/m2 for twelve weeks, concomitant with radiation in the affected breast. Standardized treatment was indicated to patients with positive hormone receptors. Results: Patients`s age averaged 53.58 years (33 years and 74 years) All patients received the planned chemotherapy, with a delay of 63.24 days, from the surgery to the first cycle of chemotherapy (20 days to 110 days. The radiation treatment was initiated in 143.4 days (90 to 205 days) on average after the surgical treatment.It was reported that 8% (n = 4) discontinued the treatment due to the toxicity of the radiation therapy: actinic dermatitis grade 3 and 4. The average number of days without radiation therapy due to toxicity was 6 days (3 to 9 days).With respect to chemotherapy, 22% (11) interrupted it because of hematologic toxicities (neutropenia, thrombocytopenia), constitutional toxicities (fatigue) and arthralgias. Regarding chemotherapy, the average time without treatment was 18 days (1 to 4 cycles).There were no cardiac or lung related adverse events. All other toxicities were well tolerated with concomitant medication. Conclusions: In our population, it is possible to carry out concomitant chemo-radiotherapy with acceptable early toxicities and compliance in patients with breast cancer.

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Stereotactic Single-Dose Radiation Therapy of Liver Tumors: Results of a Phase I/II Trial

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.1.164 ◽

2001 ◽

Vol 19 (1) ◽

pp. 164-170 ◽

Cited By ~ 385

Author(s):

Klaus K. Herfarth ◽

Jürgen Debus ◽

Frank Lohr ◽

Malte L. Bahner ◽

Bernhard Rhein ◽

...

Keyword(s):

Radiation Therapy ◽

Single Dose ◽

Radiation Treatment ◽

Liver Tumors ◽

Local Tumor Control ◽

Tumor Control ◽

Local Tumor ◽

Local Tumor Control Rate ◽

Dose Radiation

PURPOSE: To investigate the feasibility and the clinical response of a stereotactic single-dose radiation treatment for liver tumors. PATIENTS AND METHODS: Between April 1997 and September 1999, a stereotactic single-dose radiation treatment of 60 liver tumors (four primary tumors, 56 metastases) in 37 patients was performed. Patients were positioned in an individually shaped vacuum pillow. The applied dose was escalated from 14 to 26 Gy (reference point), with the 80% isodose surrounding the planning target volume. Median tumor size was 10 cm3 (range, 1 to 132 cm3). The morbidity, clinical outcome, laboratory findings, and response as seen on computed tomography (CT) scan were evaluated. RESULTS: Follow-up data could be obtained from 55 treated tumors (35 patients). The median follow-up period was 5.7 months (range, 1.0 to 26.1 months; mean, 9.5 months). The treatment was well tolerated by all patients. There were no major side effects. Fifty-four (98%) of 55 tumors were locally controlled after 6 weeks at the initial follow-up based on the CT findings (22 cases of stable disease, 28 partial responses, and four complete responses). After a dose-escalating and learning phase, the actuarial local tumor control rate was 81% at 18 months after therapy. A total of 12 local failures were observed during follow-up. So far, the longest local tumor control is 26.1 months. CONCLUSION: Stereotactic single-dose radiation therapy is a feasible method for the treatment of singular inoperable liver metastases with the potential of a high local tumor control rate and low morbidity.

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Initial Experience of Self-Expanding Metal Ureteral Stent in Recurrent Ureteral Stricture After Ureteroplasty

Frontiers in Surgery ◽

10.3389/fsurg.2021.765810 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiaoshuai Gao ◽

Jixiang Chen ◽

Zhongyu Jian ◽

Menghua Wang ◽

Wei Wang ◽

...

Keyword(s):

Ureteral Stent ◽

Ureteral Stricture ◽

Continuous Variables ◽

Median Hospital Stay ◽

Distal Ureter ◽

Before And After ◽

Stay Time ◽

Median Hospital ◽

Median Operative Time

Background: The aim of this prospective study was to assess the safety and effectiveness of self-expanding metal ureteral stent (MUS) for the treatment of recurrent ureteral stricture after ureteroplasty.Methods: We prospectively included 24 patients who underwent MUS implantation between February 2019 and August 2020. The inclusion criteria for the procedure were recurrent ureteral strictures after ureteroplasty. A paired T test was used to compare continuous variables before and after surgery.Results: A total of 24 patients were finally included in this study. The stricture site was most common on the proximal ureter 19 (79.2%), followed by distal ureter 4 (16.7%) and middle ureter 1 (4.2%). The median length of ureteral stricture is 2.5 (range 1–18) cm. The median operative time was 51.5 min, and the median hospital stay time after surgery was 3 days. Post-operative complication included pain 1 (4.2%), urinary tract infection 2 (8.3%) and hematuria 2 (8.3%). After a median follow-up of 12 months, 19/24 (83.3%) patients were clinically and radiologically successful. We endoscopically adjusted or exchanged the failed stents. The volume of hydronephrosis (124.7 ± 132.5 vs. 66.4 ± 73.2 cm3, P = 0.015), blood creatinine level (104.5 ± 45.4 vs. 80.1 ± 23.2 μmol/L, P = 0.044) and urea nitrogen level (6.9 ± 2.4 vs. 4.8 ± 1.5 mmol/L, P = 0.003) decreased significantly after a median follow-up of 12 months.Conclusions: MUS is a safe and effective way to manage recurrent ureteral strictures after ureteroplasty. This technique provides a new choice for the treatment of recurrent stricture.

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