The goal of this study was to determine the efficacy and safety of tandem ureteral stent placement in the management of malignant ureteral obstruction (MUO) refractory to single ureteral double-J stent drainage in women with gynecological malignancies.

A retrospective study was performed on 14 women (mean age, 54.5±9.6 [SD] years; range: 38–70 years) who had tandem stent placement following failed single ureteral double-J stent placement from 2012 to 2017. Survival analyses were performed with Kaplan-Meier method.

Twenty-nine successful procedures were performed on 19 ureters (19 primary stent placement and 9 exchange procedures). Technical success of primary tandem stent placement was 95% (19/20 procedures). Mean follow-up was 180.1±173.7 (SD) days (range: 62–616 days). Median estimated survival of the patients was 118 days (Q1: 261, Q3: 95; range: 62–616 days). Primary stent failure rate was 25% and assisted stent failure rate was 21.4%. There was no significant difference among survival of patients with and without tandem stent failure. Mean estimated primary stent patency and assisted stent patency were 171.4±13.8 (SD) days and 409.9±59.8 (SD) days, respectively. Four patients underwent 1 to 3 stent exchanges. Median exchange time was 181 days (Q1: 151, Q3: 191, range: 141–214 days) and technical success rate was 100%. Grade 2 and 3 complication rates were 25% and 3.6%, respectively.

Tandem ureteral stent placement is a feasible, safe and effective procedure for the management of failed ureteral double-J stent placement in women with gynecological malignancies.