PLACEMENT OF METALLIC STENTS IN URETERS OBSTRUCTED BY CARCINOMA OF THE CERVIX TO MAINTAIN RENAL-FUNCTION IN PATIENTS UNDERGOING LONG-TERM CHEMOTHERAPY

OBJECTIVE. Metallic stents, sometimes augmented by ''J'' endostents, w ere placed in ureters obstructed by advanced carcinoma of the cervix t o improve or maintain renal function in these patients at a level nece ssary to pursue long-term chemotherapy and radiation therapy. SUBJECTS AND METHODS. Seventeen ureters in 11 patients were treated with metal lic stents, which were placed by an anterograde approach in 10 patient s and by a retrograde approach in one. An anterograde ureteroneocystos tomy was necessary in two of the 11 patients. J endostents were placed for 1 month in all patients. In 10 ureters, J endostents were reintro duced during follow-up 1-48 months later. RESULTS. In 17 ureters, meta llic stents were successfully placed; in the remaining three ureters, the procedures were aborted because of technical difficulties. The goa l of improving and maintaining renal function was met in 10 patients. Serum creatinine levels returned to normal in four patients and stabil ized at a range of 2.7-3.2 mg/dl in six more patients, permit ting tre atment with chemotherapy, radiation therapy, or both. Four of the 11 p atients died within 4 months after treatment, and three more died with in 2 years. At the time of death or last follow-up, seven metallic ste nts and eight combinations of metallic stents and J endostents were pa tent. Complications were minor. CONCLUSION. Placement of metallic sten ts is recommended as an effective method to ensure patency and to faci litate cystoscopic replacement of J endostents in ureters compromised by carcinoma of the cervix. Renal function can be maintained, allowing chemotherapy Survival is governed by the effectiveness of chemotherap y and radiation therapy.