Metal mesh stents for ureteral obstruction caused by hormone-resistant carcinoma of prostate

Long-segment ureteral obstruction by hormone-refractory carcinoma of the prostate is a difficult problem to manage. J-Stents often obstruct by compression. Metal mesh stents have been used successfully in the management of extrinsic ureteral obstruction caused by malignant disease. In this paper, we review our results in three patients in terms of the defined objective of palliation.

All three patients presented with painful obstructed kidneys and renal failure from long (7-10-cm) distal ureteral strictures responding to nephrostomy drainage. Endoluminal metal mesh stents of 7 to 8-mm diameter of various lengths (depending on the size of the stricture) were implanted after antegrade balloon dilatation of the stricture by a standard technique. The case notes were reviewed for technical success, preservation of the renal units, complications, and the impact on the overall quality of life.

All three stents were placed without any complication and showed patency on contrast study. In one patient, the stent obstructed after 5 months, necessitating placement of a nephrostomy tube. In the remaining two patients, the stents obstructed within 3 months. During these 3 months, both patients had multiple admissions for stent-related complications and other symptoms of their disease. Overall quality of life was poor for these patients.

Metal mesh ureteral stents give poor palliation in distal strictures caused by hormone-refractory carcinoma of the prostate. Permanent nephrostomy may be a more acceptable alternative in these patients with short life expectancies.