Obstructive oligo-anuria revealing pelvic gynecological cancers, analysis of a series of 102 cases

Abstract

IntroductionObstructive Anuria (OA) constitutes a diagnostic and therapeutic emergency involving the vital prognosis of the patient requiring an emergency and multidisciplinary care. The etiologies are multiple and the pelvic gynecological cancers represent one of the main causes of OA. ObjectivesDescribing the epidemiological, clinical, paraclinical, etiological, therapeutic and progressive aspects of obstructive anuria of the gynecological origin, in the urology department in the University Hospital Center. Materials and methodsThis is a descriptive and retrospective study spread over a period of 4 years (2016–2019) including all the patients admitted for management of OA secondary to the pelvic gynecological cancers. Results102 patients were included in the study whose the mean age was 60 years old (36–84). The main etiologies were cervical cancer (93%), followed by endometrial cancer (5%) and ovarian cancer (2%). The mean time to consultation was 4.5 days (1–8). The main circumstances of discovery were anuria (67%), oligoanuria (21.5%), low back pain (17%) and hematuria (9%). Clinical examination found an altered general condition (Performans Status> 2) in 37.5% of the patients and an advanced local state in 96% of the patients. The means of serum creatinine and blood urea were 122 mg/l and 2.4 g/l respectively. The hemodialysis (HD) was indicated in 29.5% of patients with life-threatening hyperkalemia (Kalemia> 6.4meq/l) with cardiac distress (20.5%), hydro-sodium overload (6%) and metabolic acidosis (3%). The ultrasound-guided percutaneous nephrostomy was the main method of diversion (92%) followed by the placement of the double J stent (8%). The outcome was favorable in the majority of patients with normalization of the kidney function (88%) while 7% of cases kept chronic kidney disease. The main complication was an obstruction syndrome (41%), followed by infections of the percutaneous nephrostomy tubes (13%) and venous thrombosis of the lower limbs (3%). In addition, the mortality was estimated at 5%. ConclusionThe obstructive anuria constitutes a medico-surgical emergency involving the patient's vital prognosis. Our study notes the frequent association between the pelvic gynecological tumors and the obstructive anuria, which can be explained by the advanced stage of these tumors. This work underlines the fundamental interest of early diagnosis of these tumors to enable the prevention of the OA.