#0715
Tandem ureteric stenting for malignant ureteral obstruction: A systematic review and meta-analysis
A. Guo1, A. Jain2, M. Basto1, V. Chalasani1, K. Rasiah1, A. Chung1
1Royal
North Shore Hospital, Urology, Sydney, Australia
2Port Macquarie Base Hospital, Urology, Sydney, Australia
Introduction:
The primary aim of the present systematic review and meta-analysis is to determine the technical feasibility and safety of tandem ureteric stent insertion, and the failure rate of tandem stents in relieving malignant ureteric obstruction.
Material and methods:
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Statement. The primary study outcome was the rate of tandem stent failure and the time to failure. Failure was defined as malignant ureteral obstruction that was refractory to tandem stenting, necessitating alternative methods of drainage. Secondary outcomes included technical success, rate of adverse events, overall survival, and duration of stent patency.
Results:
The search identified 10 studies for inclusion. A total of 533 patients underwent tandem ureteric stenting for malignant ureteric obstruction. The pooled proportion of stent failure during the follow up period was 18.90% (95% CI, 12.39% – 27.73%, I2 = 66.3%) (Figure 1a). The pooled mean time to stent failure was 13.25 months (95% CI, 4.30 – 22.20 months, I2 = 98.6%) (Figure 1b). The pooled proportion of patients that died during the follow up period of included studies was 49.72% (95% CI, 34.98% – 64.52%, I2 = 86.6%), with a pooled mean survival time of 11.42 months (95% CI, 7.51 – 15.3 months, I2 = 90.7%). The pooled proportion of successful tandem ureteric stent insertions was 96.44% (95% CI, 93.40% – 98.11%, I2 = 0%) (Figure 2). Of these reported adverse events, 8.18% (95% CI 5.63% – 11.74%, I2 = 67.8%) were Clavien-Dindo grade 1 events, 19.50% (95% CI 15.51% – 24.22%, I2 = 61.5%) were Clavien-Dindo grade 2 events, and 4.72% (95% CI 2.86% – 7.68%, I2 = 0%) were Clavien-Dindo grade 3 events. There were no reported grade 4 or grade 5 events.