[Percutaneous nephrostomy in malignant ureteral obstruction]

Bladder cancer with obstructive uremia: oncologic outcome after definitive surgical management

OBJECTIVES

To report the surgical and oncologic outcomes of patients with bladder cancer who present with obstructive uremia.

METHODS

A total of 61 patients presented to our institute with obstructive oliguria or anuria concomitant with bladder cancer. The mean serum creatinine at presentation was 11.4 +/- 5.1 mg%. After stabilization of kidney function following nephrostomy drainage, only 38 patients were eligible for radical cystectomy. Analysis of the intraoperative findings, early postoperative course, definitive histopathologic findings, and long-term functional and oncologic outcome was performed. The mean follow-up period was 16.2 +/- 8.1 months (range 8 to 134).

RESULTS

Radical cystectomy with bilateral iliac lymphadenectomy was feasible in 26 patients, palliative cystectomy in 10, and ileal conduit only without cystectomy in 2. The postoperative morbidity was minimal and treated conservatively. Bladder cancer causing uremia was invasive in 94.5%, and was pathologic Stage T4 in 30.5% of cases. At the mean follow-up, treatment failure was observed in 26 patients (68.4%), with only 12 patients living free of disease and a mean serum creatinine of 1.4 +/- 0.7 mg%. Although none of the preoperative variables proved to be predictive of the oncologic outcome, significant correlation was found between the tumor stage and grade, as well as lymph node involvement, and treatment failure.

CONCLUSIONS

Although bladder cancer causing obstructive uremia is almost always muscle invasive, with a large proportion of patients presenting with locally advanced disease, an adequate number of these patients could achieve long-term disease-free survival.

[Percutaneous nephrostomy in emergencies. Report of 42 cases]

PURPOSE

Through this work we are going to demonstrate the interest and the contribution of the percutaneous nephrostomy in obstructive anuria and in pyonephrosis.

PATIENTS AND METHODS

It is a retrospective study concerning 42 cases. The average age of the patients is 50 years (19-80 years). The sex-ratio is 26 men for 16 women. The nephrostomy was realized in first intention or after failure of ascent stent on 33 patients for an obstructive anuria and nine patients for a pyonephrosis.

RESULTS

Improvement of the renal function was noted in 100% of obstructive with anuria and apyrexy in every case of pyonephrosis. No major complication arose during the realization of the nephrostomy. The long-term prognostic depends on the etiology.

CONCLUSION

The percutaneous nephrostomy constitutes a saving, effective and temporary solution in the strategy of the coverage of obstructive anuria and pyonephrosis.