Metallic stents in gynecologic cancer: an approach to treat extrinsic ureteral obstruction.

Abstract

We report on our experience with the use of self-expandable metal stents for the treatment of extramural ureteral obstruction in patients with gynecologic cancer to restore ureteral patency and to alleviate the ureterectasis and hydronephrosis proximal to the ureteral narrowing. Fourteen women (mean age 48 years) with obstructive uropathy secondary to gynecologic malignancies were treated successfully by placement of Wallstent self-expandable intraureteral metallic stents. The patients were followed for a mean period of 15 (range 9-24) months. Obstructive uropathy was resolved in all cases. In 1 patient placement of an additional, totally coaxial, stent was considered necessary because of tumor ingrowth, occurring 6 months after the procedure. In another patient, tumor overgrowth invading the borderline area between the proximal ureteric end and the metallic prosthesis was seen 12 months after stent placement causing obstruction. Thus, an additional Wallstent was implanted overlapping the initially placed stent. Patency was achieved in all the remaining ureters, during the follow-up period, without any need for further intervention. Implantation of self-expandable metal stents is a safe and effective method for bypassing ureteral obstruction due to gynecologic malignancies.