42 Percutaneous nephrostomy insertion for patients with bilateral ureteric obstruction caused by prostate cancer

Abstract

Introduction: Ureteric obstruction is a severe complication of advanced prostate cancer. Percutaneous nephrostomy (PCN) can decompress the obstructed kidney(s) and treat renal failure. This study assessed whether PCN added any survival benefit and whether bilateral PCN were necessary when both ureters were obstructed.Methods: The notes of 20 patients, who underwent urinary diversion by PCN for ureteric obstruction, were retrospectively analysed. Data pertinent to the mode of presentation, survival times and urine output of respective nephrostomies were retrieved.Results: Seventeen of the 20 patients (85%) presented with acute renal failure. 18 of the 20 patients presented with bilateral hydronephrosis. Of these, 12 patients had bilateral PCN insertion and 6 patients had unilateral PCN insertion. In those 12 patients who had bilateral PCN, 8 (66%) had a greater urine output in one PCN than the other. In the six patients who had unilateral PCN insertion, five of them had their renal failure treated. The mean survival time following PCN was 6.5 months.Conclusion: Percutaneous nephrostomy insertion will prevent immediate death in patients. However, long term survival is limited to 6.5 months. The above results would suggest that acute renal failure requiring palliative decompression may be best treated by unilateral as opposed to bilateral nephrostomy. However, a larger randomised controlled prospective study would be helpful to further assess this observation.