Long-term follow-up results and complications in cancer patients with persistent nephrostomy due to malignant ureteral obstruction

PURPOSE

We aimed to evaluate the long-term complications and predisposing factors for these complications in patients with malignant ureteral obstruction (MUO) treated with percutaneous nephrostomy (PN).

METHODS

The records of patients with MUO treated with PN between January 2015 and 2018 were retrospectively reviewed for PN dislodgement, PN obstruction, PN replacement, pyelonephritis, hospitalizations due to PN complications, and other complications due to PN such as macroscopic hematuria, skin infections, or renal/perirenal abscess.

RESULTS

Data for a total of 147 patients (229 renal units [RU], 107 males, 40 females) were evaluated. In 174 (76%) RU, PN was replaced due to PN dislodgement. The predisposing factors for PN dislodgement were follow-up time, body mass index (BMI), chemotherapy, diabetes mellitus (DM), low educational level (LEL), pyelonephritis, and catheter-related skin infections (CSRI). The PN was replaced in 40 RU due to obstruction. The predisposing factors for obstruction were follow-up time and BMI. Pyelonephritis developed at least once in 61 (41.5%) patients. Follow-up time, BMI, previous surgery, DM, and LEL were the predisposing factors for pyelonephritis. CSRI developed in 16 RU. Follow-up time, BMI, DM, and LEL were the predisposing factors for CSRI. Macroscopic hematuria developed in 11 patients. Follow-up time, previous surgery, DM, chemotherapy, and LEL were predisposing factors for macroscopic hematuria.

CONCLUSION

The most common complication in patients with MUO treated with PN was PN dislodgement. However, life-threatening complications such as macroscopic hematuria and severe infections can also occur. Patients with DM, LEL, and chemotherapy are at high risk of PN-related complications.

A rare cause of lower urinary tract symptoms: retrovesical hydatid cyst

Retrovesical cysts are extremely rare. For differential diagnosis radiologic findings and serologic tests can be used. In this article, we aimed to report our approach to diagnose and to treat a primary huge hydatid cyst in retrovesical space, between sigmoid colon and bladder. A 34-year old patient presented to our hospital with lower urinary tract symptoms (LUTS). Abdominal ultrasound reported a 14x8 cm cystic lesion adjacent to the posterior wall of the bladder. Computerized tomography revealed a 14 x 8 cm cystic mass adjacent to bladder posteriorly and prostate and seminal vesicle anteriorly in the retrovesical space. Patient received albendazole prophylaxis and intervention was planned by transperitoneal approach. In a two-year of follow-up patient did not encounter any recurrences. Retrovesical cysts may cause LUTS. With patients suffering from LUTS, hydatid cyst should be kept in mind.