The relief of ureteral obstruction by internal ureteral stent in patients with gynecologic malignancy

Prognostic significance of ureteral obstruction in primary cervical cancer

OBJECTIVES

To evaluate the prognostic significance of ureteral obstruction in women with cervical cancer and the result of aggressive urinary diversion.

METHODS

The clinical history and X-rays of 52 women with Stage III and IV cervical cancer seen at Vanderbilt University between 1981 and 1991 were retrospectively reviewed.

RESULTS

Twenty-nine (55.8%) of these patients had unilateral [15] or bilateral [14] ureteral obstruction. There was no statistically significant difference in the survival of patients whether or not ureteral obstruction was present. Ten of fourteen women with bilateral ureteral obstruction and 4 of the 15 patients with unilateral obstruction underwent urinary diversion by percutaneous nephrostomy [9] or retrograde ureteral catheterization [5]. Complications were few. Although patients who underwent urinary diversion had somewhat better survival, it was not statistically significant.

CONCLUSIONS

Some patients with ureteral obstruction due to advanced cervical cancer can be salvaged by prompt, aggressive urinary diversion, but large trials are needed to validate this approach.

Percutaneous nephrostomy in gynecologic oncology patients

Percutaneous nephrostomies were used in 34 patients with ureteral obstruction caused by gynecologic diseases. Group 1 consisted of 12 patients with untreated cervical carcinoma; group 2 consisted of six patients with recurrent cervical carcinoma; group 3 consisted of seven patients with complications of urinary conduits, and group 4 consisted of eight patients with a variety of malignant and benign gynecologic diseases causing ureteral obstruction. One perinephric hematoma and one perinephric abscess (4%) occurred during primary percutaneous nephrostomy diversion of 53 renal units. One (3%) percutaneous nephrostomy-related death caused by sepsis was observed in 34 patients. Only four (12%) patients with significant intrinsic renal disease did not have effective normalization of renal function by percutaneous nephrostomy. Percutaneous nephrostomies allow rapid and reliable urinary diversion without the morbidity and mortality of operative techniques. Percutaneous nephrostomy should be considered for relief of ureteral obstruction in patients with untreated cervical carcinoma who may enjoy prolonged palliation or cure, in patients with complications of previous urinary conduits as a temporizing method of urinary diversion, and in patients with benign or chemotherapy-sensitive pelvic malignancies causing ureteral obstruction. The use of percutaneous nephrostomy in patients with recurrent carcinoma of the cervix should be individualized on the basis of expectations for prolonged functional palliation.

Percutaneous nephrostomy catheter use in gynecologic malignancy: M.D. Anderson Hospital experience

The clinical courses of 30 patients with 41 nephrostomy catheters were followed. Duration of drainage ranged from 2 days to 15 months with a mean of 3.7 months. The most common complications were hemorrhage (28%), infection (70%), and blockage of catheter (65%). No deaths occurred as a result of these complications. Renal function recovered in 14 of 20 patients (70%) who presented with elevated creatinine values. Twenty-six of 28 patients with malignant obstruction were able to receive further therapy. The only long-term survivors presented with primary advanced cervical cancer.