Percutaneous nephrostomy and ureteral stenting in gynecologic malignancies

Barton, Desmond P.J.; Morse, Steven S.; Fiorica, James V.; Hoffman, Megan; Roberts, William S.; Cavanagh, Denis

doi:10.1016/0020-7292(93)90506-r

Cited by 17 publications

(24 citation statements)

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“…Many authors have come out against palliative urinary diversion on the grounds that it prolongs suffering [4,9,10,16]. We don't think that problems like dislodgement or obstruction of nephrostomy catheters, macrohematuria and pyelonephritis as reported by many authors [1,6,17,18] seriously impaired the quality of life in our study; 18,2% of our catheters required replacement for dislodgement or obstruction.…”

Section: Discussioncontrasting

confidence: 55%

Survival and quality of life after percutaneous nephrostomy for malignant ureteric obstruction in patients with terminal cervical cancer

Emmert¹,

Raßler

Köhler

1997

Arch Gynecol Obstet

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We describe 24 consecutive patients with cervical cancer stage III or IV who received palliative urinary diversion by percutaneous nephrostomy. All patients had proven malignant ureteric obstruction, uremia and failed ureteric stenting. 11 of 17 patients with extensive primary cancer and local lymph node involvement had an acceptable quality of life for 2 or more months while the mean survival was 5.6 months. Patients with disseminated metastasizing cancer were not satisfactorily served by nephrostomy.

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Section: Discussioncontrasting

confidence: 55%

Survival and quality of life after percutaneous nephrostomy for malignant ureteric obstruction in patients with terminal cervical cancer

Emmert¹,

Raßler

Köhler

1997

Arch Gynecol Obstet

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“…However, the almost universal oc currence of bacteriuria and candiduria within a few weeks of the percutaneous nephros tomy limits the use of this technique in pa tients slated for protracted chemotherapy [71. Retrogradeor anterogradeplacementof ure teral stents, also a minimally invasive proce dure, is successful in more than two thirds of patients [8,9]. In some patients with massive tumor in the true pelvis and direct penetra tion of the ureters, percutaneous ureteroneo cystostomy, a technique designed to traverse tumor obstructing segments of the ureter, may be necessary to gain reentry into the bladder and place the stent [101.…”

Section: Discussionmentioning

confidence: 99%

Placement of metallic stents in ureters obstructed by carcinoma of the cervix to maintain renal function in patients undergoing long-term chemotherapy.

Lang¹,

Irwin²,

Lopez-Martinez³

et al. 1998

American Journal of Roentgenology

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ErichK.Lang1'2 RobertJ. Irwin3 RicardoA. Lopez-Martinez3 JosephLaNasa, Jr.4 NabetKasabian5 RichardA. Watson3OBJECTIVE. Metallic stents, sometimes augmented by â€oe¿ Jâ€• endostents, were placedin ure ters obstructed by advanced carcinoma of the cervix to improve or maintain renal function in these patients at a level necessary to pursue long-term chemotherapy and radiation therapy.SUBJECTS AND METHODS. Seventeenuretersin 11 patientswere treatedwith me tallic stents,which were placed by an anterogradeapproach in 10 patients and by a retrograde approach in one. An anterograde ureteroneocystostomy was necessaryin two of the 11 pa tients. J endostents were placed for I month in all patients. In 10 ureters, J endostents were re introduced during follow-up 1â€"48 months later.RESULTS. In 17 ureters,metallic stentswere successfully placed;in the remainingthree ureters, the procedures were aborted because of technical difficulties. The goal of improving and maintaining renal function was met in 10 patients. Serum creatinine levels returned to normal in four patients and stabilized at a range of 2.7â€"3.2mg/dl in six more patients, permit ting treatment with chemotherapy, radiation therapy, or both. Four of the 11 patients died within 4 months after treatment, and three more died within 2 years. At the time of death or last follow-up, seven metallic stents and eight combinations of metallic stents and J endo stents were patent. Complications were minor. CONCLUSION.Placementof metallicstentsis recommendedasan effectivemethodto ensure patency and to facilitate cystoscopic replacement of J endostents in ureters compro mised by carcinoma of the cervix. Renal function can be maintained, allowing chemotherapy. Survival is governed by the effectiveness of chemotherapy and radiation therapy. U ntil recently, limited treatment options (surgical and radiothera peutic) for advanced-stage carci noma of the cervix and ovarian and endometrial neoplasms have curtailed the de mand for intervention to maintain urinary drainage. With the advent of aggressive che motherapy followed by surgery for ad vanced-stage pelvic neoplasms, the need to optimize renal function has increased be cause many chemotherapeutic protocols de pend on acceptable renal function [1â€"31. The common presentation of advanced carci noma of the cervix, with obstruction and en casement of the ureter, occlusion of the intramural ureter by contiguous extension of neoplasm into the trigone area of the bladder, or both, mandates reestablishment of drain age to pursue such protocols. This goal can be accomplished by percutaneous nephros tomy, percutaneousureterostomy, creation of a new bladder reservoir at a remote site, or placement of stents from the kidney and pel vis to the bladder [4â€"61. Percutaneous neph rostomyis a good alternativefor short-term drainage. However, the almost universal oc currence of bacteriuria and candiduria within a few weeks of the percutaneous nephros tomy limits the use of this technique in pa tients slated for protracted chemotherapy [71. Re...

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“…Multiple studies have shown both stents and nephrostomy tubes are effective methods to restore kidney function after ureteric obstruction. 2,3,10,[16][17][18][19] Advancements in and availabil- There was a trend toward a decreasing percentage in the number of patients presenting with BUO secondary to cervical cancer compared with 1982. It is possible that aggressive screening for cervical cancer over the past 25 years contributed to this observation.…”

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confidence: 99%

Acute reversible kidney injury secondary to bilateral ureteric Obstruction

Organ¹,

Norman²

2011

cuaj

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Background: Acute reversible kidney injury (ARKI) secondary to bilateral ureteric obstruction (BUO) is a common urological problem. Our goals were to describe the etiology, management and outcomes of such patients identified between 2006 and 2009 and to compare them with a similar historical study published in 1982. Methods: Chart review was performed on 49 patients with AKRI secondary to BUO. ARKI was defined as ≥33% decrease in serum creatinine after intervention. Those with malignant and benign causes of obstruction were identified and management and outcome data were collected. Results: Of these 49 patients, 83% had BUO secondary to malignancy, 28% of these presenting for the first time. Prevalence of bladder cancer was increased (p = 0.04) and cervix trended lower (p = 0.07) compared with the earlier study; prostate cancer was unchanged (p = 0.51). The average survival was 239 days; 90% of patients died within a year after presenting with BUO from a malignant etiology. Compared with the 1982 group, there were trends towards a decrease in the frequency of retroperitoneal fibrosis (p = 0.08) and an increase in bilateral ureteric calculi (p = 0.16) in the benign group. Conclusions: Patients with ARKI secondary to BUO most likely have an underlying malignancy, with almost a third of them being diagnosed for the first time. Prevalence of bladder cancer increased while cervical cancer trended lower. The cause for the former is unclear; the latter may be due to aggressive screening. Prostate cancer remained unchanged despite the widespread implementation of prostate-specific antigen testing. Patients with an underlying malignancy do poorly and those with a newly diagnosed malignancy do worst. Those with ARKI secondary to benign causes did well.

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Percutaneous nephrostomy and ureteral stenting in gynecologic malignancies

Cited by 17 publications

References 0 publications

Survival and quality of life after percutaneous nephrostomy for malignant ureteric obstruction in patients with terminal cervical cancer

Survival and quality of life after percutaneous nephrostomy for malignant ureteric obstruction in patients with terminal cervical cancer

Placement of metallic stents in ureters obstructed by carcinoma of the cervix to maintain renal function in patients undergoing long-term chemotherapy.

Acute reversible kidney injury secondary to bilateral ureteric Obstruction

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