Impact of percutaneous nephrostomy in South African women with advanced cervical cancer and obstructive uropathy

Abstract

Objectives: South Africa women with cervical carcinoma present at younger ages and the majority with advanced-stage disease. Certain patients may have a favourable outcome after placement of a percutaneous nephrostomy (PCN) for obstructive uropathy in cervical cancer. Methods: A retrospective audit was conducted at the Gynaecological Oncology Unit, University of Pretoria. All patients with primary untreated cervical cancer with renal impairment secondary to obstructive uropathy were included. Urea, creatinine and potassium were recorded for patients receiving PCN before insertion and after treatment. Results: In total, 54 patients were included. The mean age was 49.5 years. The number of patients receiving PCN was 28 (51.9%) and 26 (48.1%) women did not. Altogether, 25% of patients had improvement in renal function after insertion of PCN and in 10.3% renal function worsened. Some 50% of these patients received palliative radiotherapy, 7% started therapeutic chemoradiation and 7% of patients completed treatment. Response to treatment was unknown for 21% of patients, 7% showed partial response and 10.7% died of their disease. In the control group, 15.4% of patients had severe renal failure; 7.7% of patients never started treatment and 7.7% received palliative radiotherapy; 11.5% died of their disease. Some 26.9% of patients without PCN fell in the renal failure group, of whom 19.2% received palliative radiotherapy. Conclusion: PCN in patients with cervical cancer and obstructive uropathy, even if HIV positive, is safe with minimal complications. An improvement in renal function was shown after insertion. PCN improved the number of patients qualifying for initiation and completion of treatment.

Beyond entrepreneurship education: business incubation and entrepreneurial capabilities

“…Consequently, it can be argued that business incubation expands entrepreneurial capabilities beyond mere entrepreneurship learning because it provides access to other relevant resources. This capability set includes certain entrepreneurial and managerial competencies (Morris et al, 2013), as well as access to relevant physical, informational, financial and other resources needed for entrepreneurial success (Van Aardt et al, 2008).…”

Survival outcomes of patients with cervical cancer and accompanying hydronephrosis: A systematic review of the literature

“…On the other hand, complications of percutaneous nephrostomy seem to be high as the rates of urinary tract infections range between 20 and 50% and of postoperative ureteral obstruction due to advancing disease of catheter dislodgement between 10 and 40%. 8,25,37-39 Nevertheless, in their majority they seem to be of mild to moderate severity and; thus, do not affect the quality of life of patients. However, since 1996, Emmert et al .…”

“…41 Recently van Aardt confirmed this hypothesis as they also observed that nephrostomy may benefit patients with uremia and primary untreated locally advanced disease, as it may restore blood urea nitrogen levels to normal and; thus, permit the implementation of chemotherapy and radiotherapy that may prolong the survival of these patients. 8 Taking this latter information into account it seems obvious that more information is needed to clarify if obstructive uropathy has the same impact among patients with stage IIb, III and IVa cervical cancer. To date, it is well known that these subgroups of patients have different 5-year survival outcomes and it would be of significant benefit if research would effectively designate whether this is primarily the result of obstructive uropathy, which is generally expected to be more prevalent in patients with stage ≥III disease.…”

“…6 When stenting is not feasible, percutaneous nephrostomy has been suggested as an alternative mean to help renal function and seems to be promising as a mean that could help complete radiotherapy and chemotherapy. 7,8 Nevertheless, to date the method that is used to facilitate urinary diversion is highly dependent on physician`s preference as there is an absolute lack of recommendations concerning the management of cancer patients. 9…”

Factors Affecting Survival Outcome After Percutaneous Nephrostomy as Palliative Urinary Diversion in Obstructive Uropathy due to Advance Cervical Cancer Patients

“…Although urinary diversion procedures can certainly improve the quality of life of advanced cervical cancer patients, current evidence suggests that urinary diversion does not significantly increase the survival rate of cervical cancer patients (Pergialiotis et al, 2019). In addition, several complications, although rare, have been associated with the nephrostomy procedure in cervical cancer, including pneumothorax, bowel injury, pararenal abscess, pyelonephritis, and urinoma (Van Aardt et al, 2017). This study, therefore, aims to identify the determinants of survival rate in cervical cancer patients undergoing nephrostomy for obstructive uropathy, and identify the subset of patients that would benefit the most from this procedure.…”