Nonoperative urinary diversion for malignant ureteral obstruction

Abstract

The management of malignant ureteral obstruction (MUO) has undergone major changes due to the availability of percutaneous drainage techniques and new ureteral stents for endoscopic insertion. These procedures are less morbid than conventional surgical techniques so that the indications for urinary diversion due to untreated or relapsing malignancy have to be reconsidered. During the period of technological change from 1978 to 1984, 135 patients with unilateral (37) or bilateral (98) MUO were managed. Open nephrostomy is now almost never necessary. Initial retrograde ureteral stenting (RS) was successful under local anaesthesia in 41% of patients. Forty-seven had percutaneous nephrostomy (PN), nine of whom underwent antegrade ureteral stenting (AS) and elimination of external appliances. Twenty-nine patients underwent miscellaneous open procedures mostly in the earlier years, with a 57% morbidity rate compared to the minimal morbidity associated with the newer techniques. The overall mean survival post diversion was 9.9 months, which is significantly longer than that reported using open procedures. MUO can now be successfully relieved with little morbidity and frequently without the use of external urine collection devices. The relative ease of diversion can complicate decision making in patients with progressive renal failure due to bilateral MUO.

Success, Effectiveness and Safety of Combined Sonographic and Fluoroscopic Guided Percutaneous Nephrostomy in Malignant Ureteral Obstruction

“…Malignancy of pelvic origin is the commonest cause of malignant ureteral obstruction [10] as also found in our study with 94% patients. Jose Benito et al [11] found bilateral obstruction in 68.75% patients with pelvic tumours to be the cause whereas tumours from distant sites mostly caused unilateral obstruction 11 and these findings were similar to our study.…”

Stent failure in the management of malignant extrinsic ureteral obstruction: Risk factors

“…1 Similarly, another study advocated primary PCN in patients with urological cancer. 11 Although we normally selected ureteral stenting for more stable patients, some stent failure still occurred.…”

Endourologic Management of Malignant Ureteral Obstruction: Indications, Results, and Quality-of-Life Issues

“…2,3,[5][6][7][8][9][10] Therefore, it is debatable whether urinary diversion by means of internal stent or nephrostomy catheter placement offers some benefit for cancer patients with life-threatening comorbidities unless it facilitates or follows certain therapeutic anticancer treatment. 5,[11][12][13][14] In any other case, the patient's right to a peaceful death from uremia when there is no hope for cure or palliation should be taken into account when concerns are raised regarding quality of life during those final days. 1,2 There is a relative lack of criteria, however, for the identification of those patients who would most likely benefit from relief of obstruction by either percutaneous nephrostomy or endoscopic stent placement.…”

“…Results from early series reported very low success rates for primary retrograde placement of a stent, rarely exceeding 50%. 2,12,40,47,48 Interestingly, in more recent studies, there is a significant improvement in the success rate of initial retrograde stent placement. Retrograde insertion of a stent has been technically successful in an average of 85% of cases, considering results from recent series as depicted in Table 1.…”