Predictor of Successful DJ Stent Insertion in Advanced Cervical Cancer

Kadek Budi Santosa; Made Moniaga Prawira; Ida Bagus Putra Pramana; Pande Made Wisnu Tirtayasa; Wayan Yudiana; Gede Wirya Kusuma Duarsa; Anak Agung Gede Oka

doi:10.3889/oamjms.2020.5159

Authors

Kadek Budi Santosa Department of Urology, Medical Faculty of Udayana University, Sanglah Hospital, Denpasar, Indonesia
Made Moniaga Prawira Medical Doctor, General Practitioner, Medical Faculty of Wijaya Kusuma University, Surabaya, Indonesia
Ida Bagus Putra Pramana Department of Urology, Medical Faculty of Udayana University, Sanglah Hospital, Denpasar, Indonesia
Pande Made Wisnu Tirtayasa Department of Urology, Medical Faculty of Udayana University, Sanglah Hospital, Denpasar, Indonesia
Wayan Yudiana Department of Urology, Medical Faculty of Udayana University, Sanglah Hospital, Denpasar, Indonesia
Gede Wirya Kusuma Duarsa Department of Urology, Medical Faculty of Udayana University, Sanglah Hospital, Denpasar, Indonesia
Anak Agung Gede Oka Department of Urology, Medical Faculty of Udayana University, Sanglah Hospital, Denpasar, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.5159

Keywords:

Cervical cancer, DJ stents, Hydronephrosis

Abstract

BACKGROUND: Metastatic cervical cancer in the ureter may lead to obstructive uropathy due to mechanical ureteral blockage. The insertion of a double J (DJ) stent is a urinary diversion option that can be offered to the patients, but it becomes challenging due to the high rate of failures.

AIM: The aim of the study was to determine the factors that predict the success of DJ stent insertion in obstructive uropathy due to advanced cervical cancer.

MATERIALS AND METHODS: The patients studied were those with obstructive uropathy due to advanced cervical cancer from 2017 to 2020 in Sanglah General Hospital. The research subjects were divided into two groups: First were the samples of successful DJ stent insertions and the second were those that failed. In the analysis, the Chi-square tests were used for categorical data, while the independent t-tests were used for normally distributed data. Logistic regression analyses which involved both the univariate and multivariate were conducted to determine the factors that aided the success of DJ stent insertions.

RESULTS: Retrograde stent insertion of DJ stents was conducted on 100 patients. Successful insertions were found in 57 patients (57%), while those that failed were observed in 43 subjects (43%). The results of multivariate regression analyses showed that low-grade hydronephrosis (odd ratios [OR] = 62.024; p = 0.000; confidence interval [CI] = 9.485–405.596), normal albumin levels (OR = 5.856; p = 0.018; CI = 1.359–25.243), lower Federation of Gynecology and Obstetrics (FIGO) staging (OR = 14.985; p = 0.007; CI = 2.108–106.536), and a history of radiotherapy (OR = 8.758; p = 0.005; CI = 1.943–39.477) were the significant factors for predicting the success of DJ stent insertions.

CONCLUSION: Low-grade hydronephrosis, normal albumin levels, lower FIGO staging, and a history of radiotherapy are the strong factors for predicting the success of DJ stent insertions in obstructive uropathy due to advanced cervical cancer.

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References

Darmayasa IM, Made BD, Hari WS. Kualitas Hidup Pasien Kanker Serviks Yang Dirawat di Ruang Cempaka Ginekologi RSUP Sanglah Denpasar. Jakarta: Disampaikan Pada PIT HOGSI X; 2017. https://doi.org/10.15562/medicina.v50i2.822

Soetojo S, Nurdin AT. Charateristics of gynecological abnormalities and types of urine diversion at Dr Soetomo Hospital, Surabaya, Indonesia, in three-year period. Fol Med Indones. 2019;55:134-8. https://doi.org/10.20473/fmi. v55i2.14347

Oktaviani BD, Sriwidyani NP, Sumadi IW. Karakteristik klinikopatologi penderita kanker serviks uteri berdasarkan data di laboratorium patologi anatomi RSUP Sanglah Denpasar Tahun 2011-2015. E J Med Udayana. 2018;7(8):1-6. https://doi. org/10.35790/ecl.8.1.2020.27814

Cohen WM, Freed SZ, Hasson J. Metastatic cancer to the ureter: A review of the literature and case presentations. J Urol. 1974;112(2):188-9. https://doi.org/10.1016/s0022-5347(17)59679-2 PMid:4843329

Arvind NK, Singh O, Gupta S, Ali Q. Ureteral metastasis as the presenting manifestation of pancreatic carcinoma. Rev Urol. 2013;15(3):124-30. PMid:24223025

Kouba E, Wallen EM, Pruthi RS. Management of ureteral obstruction due to advanced malignancy: Optimizing therapeutic and palliative outcomes. J Urol. 2018;180(2):444-50. https://doi. org/10.1016/j.juro.2008.04.008 PMid:18550089

Tan S, Tao Z, Bian X, Zhao Y, Wang N, Chen X, et al. Ureteral stent placement and percutaneous nephrostomy in the management of hydronephrosis secondary to cervical cancer. Eur J Obstet Gynecol Reprod Biol. 2019;241:99-103. https://doi. org/10.1016/j.ejogrb.2019.08.020 PMid:31484100

Ahmad I, Pansota MS, Tariq M, Saleem MS, Tabassum SA, Hussain A. Comparison between Double J (DJ) ureteral stenting and Percutaneous Nephrostomy (PCN) in obstructive uropathy. Park J Med Sci. 2013;29(3):725-9. https://doi.org/10.12669/ pjms.293.3563 PMid:24353616

Wang JY, Zhang HL, Zhu Y, Qin XJ, Dai B, Ye DW. Predicting the failure of retrograde ureteral stent insertion for managing malignant ureteral obstruction in outpatients. Oncol Lett. 2016;11(1):879-83. https://doi.org/10.3892/ol.2015.3961 PMid:26870299

Noegroho BS, Mustafa A. Predictive factor for successful retrograde ureteral stent insertion in obstructive uropathy due to advanced cervical cancer. Urogynaecologia. 2019;31(1):221. https://doi.org/10.4081/uij.2019.221

Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: Introduction to the system used by the society for fetal urology. Pediatr Radiol. 1993;23(6):478-80. https://doi. org/10.1007/bf02012459 PMid:8255658

Sobin LH, Wittekind L. International Union Against Cancer (UICC) TNM Classification of Malignant Tumours. 6th ed. Hoboken, NJ: Wiley; 2002. p. 155-7.

Chan ES, Matsuda T. Endourology Progress Technique, Technology and Training. Singapore: Springer Nature; 2019.

Yamagami T, Ide K, Nishio K. Studies on the pathophysiology of ureteral lesion in treatment for the uterine cervical cancer. Kurume Med J. 1973;20(2):113-8. https://doi.org/10.2739/ kurumemedj.20.113

Singh I, Strandhoy JW, Assimos DG. Pathophysiology of urinary tract obstruction. In: Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2012. p. 1087-120. https:// doi.org/10.1016/b978-1-4160-6911-9.00040-2

Huang WC, Yang JM, Yang YC, Dan Yang SH. Ultrasonographic characteristics and cystoscopic correlates of bladder wall invasion by endophytic cervical cancer. Ultrasound Obstet Gynecol. 2006;27(6):680-6. https://doi.org/10.1002/uog.2775 PMid:16710879

Chou CY, Hsu KF, Wang ST, Huang SC, Tzeng CC, Huang KE. Accuracy of three-dimensional ultrasonography in volume estimation of cervical carcinoma. Gynecol Oncol. 1997;66(1):89-93. https://doi.org/10.1006/gyno.1997.4714

Danilovic A, Antonopoulos IM, Mesquita JL, Lucon AM. Likelihood of retrograde double-J stenting according to ureteral obstructing pathology. Int Braz J Urol. 2005;31(5):431-6. https:// doi.org/10.1590/s1677-55382005000500003

Wenzler DL, Kim SP, Rosevear HM, Faerber GJ, Roberts WW, Wolf JS. Success of ureteral stents for intrinsic ureteral obstruction. J Endourol. 2008;22:295-9. https://doi.org/10.1089/end.2007.0201 PMid:18294036

Pedamallu R, Subramanian S. Factors predicting success rate of retrograde ureteric stenting in managing patients with ureteric obstruction-our experiences in a South Indian tertiary institute. Internet J Urol. 2015;14(1):1-7.

Higgins C. Urea and the Clinical Value Measuring Blood Urea Concentration. Available from: http://www.acutecaretesting.org. [Last accessed on 2020 May 23].

Yu SH, Ryu JG, Jeong SH, Hwang EC, Jang WS, Hwang IS, et al. Predicting factors for stent failure-free survival in patients with a malignant ureteral obstruction managed with ureteral stents. Korean J Urol. 2013;54(5):316-21. https://doi.org/10.4111/kju.2013.54.5.316 PMid:23700497

Yoon JH, Park S, Moon KH, et al. Renal function is associated with prognosis in stent-change therapy for malignant ureteral obstruction. Investig Clin Urol. 2018;59(6):376-82. https://doi. org/10.4111/icu.2018.59.6.376 PMid:30402570

Chung SY, Stein RJ, Landsittel D, Davies BJ, Cuellar DC, Hrebinko RL, et al. 15-year experience with the management of extrinsic ureteral obstruction with indwelling ureteral stents. J Urol. 2004;172(2):592-5. https://doi.org/10.1097/01. ju.0000130510.28768.f5 PMid:15247739

Chitale SV, Scott-Barrett S, Ho ET, Burgess NA. The management of ureteric obstruction secondary to malignant pelvic disease. Clin Radiol. 2002;57(12):1118-21. https://doi. org/10.1053/crad.2002.1114 PMid:12475538

Liu YM, Ni LQ, Wang SS, Lv QL, Chen WJ, Ying SP. Outcome and prognostic factors in cervical cancer patients treated with surgery and concurrent chemoradiotherapy: A retrospective study. World J Surg Oncol. 2018;16:18. https://doi.org/10.1186/ s12957-017-1307-0 PMid:29378625