Mortality and Complications Associated with Percutaneous Nephrostomy in Patients with Ureteral Obstruction Related to Advanced Cervical Cancer

Abstract

Introduction: Percutaneous nephrostomy is a well-established technique leading to the rapid resolution of ureteral obstruction and recovery of renal function in patients suffering from obstructive uropathy. However, its role in managing renal failure secondary to obstruction due to advanced abdominal neoplasia remains controversial. Objective: Describing the demographic variables, the complications associated with intervention, the course of obstructive uropathy and several outcomes. Materials and methods: 106 cases suffering from advanced cancer of the cervix and ureteral obstruction treated with percutaneous nephrostomy were included in the study. The patients were divided into 2 groups; 37 women with locally advanced, recently diagnosed cancer of the cervix which had not been treated so far were included in group A and 69 patients having recurrent tumours were included in group B. Results: 106 women, aged 24 to 75 (46,2 mean, SD±13,1), were included in this study; 9 (8,5%) had cancer of the cervix stage IIB, 68 (64%) had tumours stage IIIB and 29 (27,5%) were suffering from IVA stage. 102 women received pelvic radiotherapy plus brachytherapy and 4 were treated with chemotherapy plus radiotherapy concomitantly. 90 patients were diagnosed as suffering bilateral urinary obstruction; this was unilateral in 16 of them. 90% of the patients had abnormal renal function tests when undergoing the procedure. 13,2% of the patients presented bleeding following the procedure, 26% had hydro-electrolytic alterations, 12% of the patients had intraor peri-renal abscesses and 6% had an infection at the insertion site. The mean of how long nephrostomy was applied was 5,2 and 6,9 months for groups A and B respectively. 53% of the patients required 1 or more changes of catheter during this time and 147 episodes of infection of the urinary routes were documented (3,12 infections for each 100 days/catheter). Recurrent infection was more frequent in patients from group B (p=0,03), in those with an albumin level less than 2.5 mg/dl (p=0,011), in those who had been diagnosed as having rectal or vesicovaginal fistula (p = 0,02) and in those requiring more than 2 changes of catheter (p=0,05). 37% (n=39) of the patients died from sepsis having a urinary origin. Average stay in hospital (DPVU) was 71 days and mean survival 14,9 and 7,3 months in groups A and B, respectively. The average number of days of being hospitalised attributable to urinary infection following nephrostomy was 20,3 days. Conclusion: DPVU is not recommendable in patients suffering from recurrent disease (in spite of having a good base functional state) due to the large proportion of ascribable complications, especially of infectious origin.