140 Five Year Single-Unit Experience and Outcomes of Renal Decompression for Ureteral Obstruction: A Retrospective Analysis of 102 Kidney Units

Abstract

Abstract Aim Renal decompression following ureteral obstruction is a common urological emergency. Malignant obstruction patients often have poor life-expectancy, and the impact of decompression on survival is questionable [1]. We herein review outcomes of ureteral obstruction management in a single unit. Method Records of nephrostomy requests in Ysbyty Gwynedd between January 2017 and December 2021 were retrospectively reviewed. Information on patient demographics, primary pathology, performance status (PS), change in renal function and outcomes were recorded. Results Over 60 months, 102 nephrostomies were performed. Benign obstructions constituted 30.4% (n = 31) of cases. Of 71 cancer cases, 9 were re-insertions due to complications. Cancer group was associated with high and early deaths (11.3%, 64.5% and 85.5% at 3, 12 and 60 months, respectively) with only 1 in 5 kidney units illustrating improvement in renal function following decompression. All cancer patients were frail, with performance status of 2 (63%) and 3 (37%). Following nephrostomy insertion, 69.3% of kidney units developed urinary infection and/or sepsis requiring treatment. Only about 1 in 2 (53%) cancer patients received further oncological treatment (chemo- and /or radiotherapy). Though ante grade ureteric stenting was attempted in 23 kidney units following nephrostomy insertion for cancer, only 21 were successful and 2 of those blocked within 14 days. Conclusions Decompression of malignant ureteral obstruction may not improve survival and can involve multiple interventions with quality-of-life implication. Hence, the decision to decompress should not be the default and would therefore need to be individualized, adopting a multidisciplinary approach.