Benefit of percutaneous nephrostomy in malignant ureteric obstruction

Malignant ureteric obstruction decompression: how much gain for how much pain? A narrative review

“…This must be balanced against a patient's expectation of quantity and quality of life. This is of course is a challenging consultation; particularly in the acute setting when such patients often present (69). Despite extensive retrospective publications and several review articles, there is a paucity of data assessing the important issues of quality of life and prognostication in this cohort of patients.…”

“…Comparison of prognostication tools demonstrates patients with none or 1 risk factor have a more favourable outcomes with 12 month survival ranging from 20% to 78% (27,41,69,70) and a median survival ranging between 9 and 13 months (29,35,37). In those patients with 'intermediate' risk factors (see table 4), median survival ranged from 5.7 to 8.2 months (29,35,37).…”

“…Sixteen papers with a total of 2061 patients investigated various factors and their ability to prognosticate (3,9,10,23,24,27,29,30,35,37,41,53,60,(69)(70)(71) in these patients.…”

“…The most frequently found statistically significant indicators of poor prognosis were low serum albumin (10,29,35,41,71), no further treatment options (3,23,37,53), number of malignancy related events (pleural effusion, metastatic disease, ascites) (10,29,35,41), performance status of 2 or worse on the European cooperative cancer group (ECOG) (9,23,53,71), the presence of metastatic disease (27,60), and hyponatremia (29,35). Two papers divided patients into groups depending on treatment options available; those with no treatment options had 0% 12 month survival and a median survival of 38 days (69,70). Combining these parameters with a larger patient group may help develop a prognostication tool for clinicians to aid decision-making.…”