Predictors for failure of endoscopic ureteric stenting in patients with malignant ureteric obstruction: systematic review and meta-analysis

Abstract

Objective: To determine the factors for failure of endoscopic ureteric stenting in patients with malignant ureteric obstruction.

Methods: We performed a search strategy in the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), the Literatura Latino-Americana e do Caribe em Ciências da Saúde database (LILACS), and the Cochrane Central Register of Controlled Trials (CENTRAL) databases. We included patients with malignant ureteric obstruction, who had a JJ catheter insertion. The studies reported the percentage of failure and risk factors, e.g. bladder invasion or deformity of the trigone, hydronephrosis, renal failure, previous radiotherapy, age, obstruction aetiology, and patient's health status. We performed a meta-analysis using R software ('meta' and 'metafor' libraries).

Results: We included nine studies that met the inclusion criteria, with 761 patients and an average age of 60.5 years. The studies assessed the time to failure during the first 30 days. The reported failure rate was 32% (95% confidence interval [CI] 21-45%; I² = 88%). Regarding risk factors for failure, bladder invasion or deformity of the trigone had a hazard ratio (HR) of 4.8 (95% CI 1.28-8.5; I² = 97.4%); severe hydronephrosis had a HR of 3.92 (95% CI 0.32-7.52; I² = 93.9%); and age <65 years had a HR of 0.93 (95% CI 0.8-0.9; I² = 0%).

Conclusions: We found a high probability of failure for endoscopic urinary decompression in patients with malignant ureteric obstruction. Factors such as bladder invasion or deformity of the trigone and age >65 years had an increased risk of failure.

Keywords: #uroonc; #utuc; bladder invasion; hydronephrosis; malignant ureteric obstruction; obstructive uropathy; ureteric obstruction; ureteric stent; urinary diversion.