ANTEGRADE STENTING OF MALIGNANT URETERAL STRICTURES

Renal failure due to malignant ureteral obstruction presents a management dilemma because there is invariably advanced disease. We review our experience with 28 patients referred to antegrade ureteral stenting of malignant ureteral obstruction. Antegrade stenting was successful in 17 and unsuccessful in 11. In the former group, mean survival was 14.3 months (range 0.5-92 months), whereas in the latter mean survival was 3.8 months (range 0.3-14 months). Our experience is that when successful, intervention does prolong life. We challenge the widespread belief that such intervention is not justified. Acknowledging that each case should be dealt with on its merits, we advocate that if nephrostomy drainage is performed for malignant ureteral obstruction, such patients deserve at least an attempt at antegrade stenting. Our modification to the technique uses a 12f Amplatz fascial dilator to create a coaxial system, allowing greater guide-wire and catheter control.