Factors Associated with Stent Change and Prognosis in Patients with Malignant Ureteral Obstruction.

Purpose: To identify factors associated with stent changes and prognosis in patients with malignant ureteral obstruction (MUO) undergoing de novo retrograde ureteral stenting. Materials and Methods: A retrospective cohort study was conducted at a tertiary referral center for consecutive MUO patients referred and initially managed with a ureteral stent. Multivariable regression models evaluated factors associated with the following outcomes: number of stent changes, time to first stent change, and overall survival. Results: A total of 120 patients from May 2009 to December 2019 were included; mean age was 63 years, majority (76.7%) were women, median duration of follow-up was 6.1 months. Majority (75%) of patients did not require a stent change at 3 months follow-up. Patients with a history of pelvic radiation (subdistribution hazard rate [sHR] 2.12, 95% confidence interval [CI] 1.23-3.67, p = 0.007) and with a history of bowel resection (sHR 2.06, 95% CI 1.05-4.03, p = 0.036) were independently associated with earlier stent changes. Patients with gastrointestinal (GI) malignancy (hazard rate [HR] 14.1, 95% CI 2.66-74.19, p = 0.0019) and proximal ureter obstruction (HR 2.49, 95% CI 1.21-5.14, p = 0.0136) were associated with higher rate of all-cause mortality. Conclusions: The majority of patients did not require stent change at their first stent surveillance cystoscopy at 3 months follow-up. Patients with a history of pelvic radiation or bowel resection were more likely to require stent change during their stent surveillance visits. GI malignancy and proximal ureter obstruction were associated with higher rates of mortality.