Tandem ureteral stents in the management of double-J stent dysfunction in gynecological malignancies

The goal of this study was to determine the efficacy and safety of tandem ureteral stent placement in the management of malignant ureteral obstruction (MUO) refractory to single ureteral double-J stent drainage in women with gynecological malignancies.

A retrospective study was performed on 14 women (mean age, 54.5±9.6 [SD] years; range: 38-70 years) who had tandem stent placement following failed single ureteral double-J stent placement from 2012 to 2017. Survival analyses were performed with Kaplan-Meier method.

Twenty-nine successful procedures were performed on 19 ureters (19 primary stent placement and 9 exchange procedures). Technical success of primary tandem stent placement was 95% (19/20 procedures). Mean follow-up was 180.1±173.7 (SD) days (range: 62-616 days). Median estimated survival of the patients was 118 days (Q1: 261, Q3: 95; range: 62-616 days). Primary stent failure rate was 25% and assisted stent failure rate was 21.4%. There was no significant difference among survival of patients with and without tandem stent failure. Mean estimated primary stent patency and assisted stent patency were 171.4±13.8 (SD) days and 409.9±59.8 (SD) days, respectively. Four patients underwent 1 to 3 stent exchanges. Median exchange time was 181 days (Q1: 151, Q3: 191, range: 141-214 days) and technical success rate was 100%. Grade 2 and 3 complication rates were 25% and 3.6%, respectively.

Tandem ureteral stent placement is a feasible, safe and effective procedure for the management of failed ureteral double-J stent placement in women with gynecological malignancies.