Acute kidney injury due to bilateral malignant ureteral obstruction: Is there an optimal mode of drainage?

Abstract

There is a well-known relationship between malignancy and impairment of kidney functions, either in the form of acute kidney injury or chronic kidney disease. In the former, however, bilateral malignant ureteral obstruction is a surgically correctable factor of this complex pathology. It warrants urgent drainage of the kidneys in emergency settings. However, there are multiple controversies and debates about the optimal mode of drainage of the bilaterally obstructed kidneys in these patients. This review addressed most of the concerns and provided a comprehensive presentation of this topic from the recent literature. Also, we provided different perspectives on the management of the bilateral obstructed kidneys due to malignancy. Despite the frequent trials for improving the success rates and functions of ureteral stents, placement of a percutaneous nephrostomy tube remains the most recommended tool of drainage due to bilateral ureteral obstruction, especially in patients with advanced malignancy. However, the disturbance of the quality of life of those patients remains a major unresolved concern. Beside the unfavorable prognostic potential of the underlying malignancy and the various risk stratification models that have been proposed, the response of the kidney to initial drainage can be anticipated and evaluated by multiple renal prognostic factors, including increased urine output, serum creatinine trajectory, and time-to-nadir serum creatinine after drainage.

Unveiling the Challenges in Tandem Ureteral Stent Management for Malignant Ureteral Obstruction: Failure Rate, Risk Factors, and Durability of Their Replacement

“…While reconstructive strategies exist, the grim prognosis of the majority of these patients, alongside their frail state, motivates treatment in a less invasive manner. Due to the high failure rate of single ureteral stent insertion, other approaches have been pursued, such as tandem ureteral stent insertion [ 3 , 14 , 20 ].…”

Serum creatinine trajectory after drainage of kidneys with bilateral malignant ureteral obstruction: a prospective non-randomized comparative study

“…Firstly, similar values have frequently been reported for the time-to-nadir in the literature with a range of 1–3 weeks [ 1 , 11 , 17 , 18 ]. Secondly, we aimed to avoid the effects of other potential confounding factors of prolonged indwelling urinary catheters such as infections, slippage and obstruction which become inevitable and influence the effectiveness of drainage and SCr stabilization [ 19 , 20 ]. Thirdly, the obstructions in the current study were mostly acute and included only patients with mild-to moderate degrees of hydronephrosis.…”

“…This concept represents a common attitude in the recently reviewed literature. The importance and main aim of reduction of SCr should be avoidance of the inconveniences of dialysis and the balance between this benefit and the disturbance of quality of life of those patients [ 1 , 20 ].…”

Bilateral ureteral obstruction caused by a detrusor wall thickness: Case report and review of literature

“…Imaging studies are an excellent diagnostic tool, the CT scan is the best imaging modality for the etiological diagnosis [3]. Nevertheless, bladder thickening and bilateral ureterohydronephrosis can mimic features seen in vesical carcinoma [2,3].…”

“…Imaging studies are an excellent diagnostic tool, the CT scan is the best imaging modality for the etiological diagnosis [3]. Nevertheless, bladder thickening and bilateral ureterohydronephrosis can mimic features seen in vesical carcinoma [2,3]. Cystoscopy enables visualization of the macroscopic appearance of normal mucosa without suspicious bladder lesions, and the diagnostic of an anatomic obstruction [2].…”