Gynecological malignancy with obstructive uropathy patient profile in Cipto Mangunkusumo Hospital: Our 2-year experience

Abstract

Introduction: Gynecological malignancies are one of the most common causes of death from cancer in women. Hydronephrosis or obstructive uropathy is the most common finding in patients with gynecological malignancy. This study aimed to describe the profile of obstructive uropathy patients causes of gynecology malignancies treated in our center from 2019 to 2021. Method: From January 2019 to January 2021, obstructive uropathy patients with gynecological malignancies who underwent DJ stent or nephrostomy insertion procedures at Cipto Mangunkusumo Hospital were included in this prospective study. Patients with a history of urinary diversion or other diseases that may cause urinary tract obstruction were excluded. Result: One hundred and twenty-one patients with gynecological malignancies with obstructive uropathy were included. Cervical carcinoma was the most common cause, followed by ovarian carcinoma and endometrial carcinoma. The percentages of bilateral, right-, and left-sided stenting were 72%, 18%, and 10%, respectively. Most of them were grade 3 or grade 4 hydronephrosis. Percutaneous nephrostomy was mainly used for 69,4%, and only 17% of patients experienced a polyuria episode. Conclusion: Most cases of obstructive uropathy were caused by cervical malignancies, with bilateral obstruction due to cervical cancer occurring in most cases. Nephrostomy is the method of choice for urinary drainage in our center.

Predictive Factors of Successful Double J Stent Insertion Among Advanced Cervical Cancer Patients

“…Our research showed that DJ stent placement was successful in 43 (48.9%) out of 88 patients, while unsuccessful stent insertion resulted in the need for nephrostomy. Our results differ significantly from a similar study conducted by Affan et al, in which 69.2% of cervical cancer patients required nephrostomy [ 3 ]. Obstructive uropathy in cervical cancer can lead to the development of hydronephrosis and kidney failure, both of which have a poor prognosis.…”

“…Gynecological cancers such as ovarian, uterine, and cervical cancer are frequent causes of obstructive uropathy in women. Concurrent radiation and cisplatin-based chemotherapy are recommended as the first line of treatment for locally advanced cervical cancer, as they can lower the risk of death and recurrence [ 3 , 10 ].…”

“…Prior studies suggest that urinary diversion may improve renal function in cervical cancer patients, but its impact on overall survival rates is yet to be determined. According to Nobrega et al, treatments such as percutaneous nephrostomy and ureteral stent implantation may not provide any clinical benefits in cases of severe kidney injury and may even increase complications [ 3 , 10 ].…”

“…This condition arises due to external compression, which can cause obstructions in the renal collecting system, leading to distention of the renal calyces and the onset of hydronephrosis. This condition is potentially life-threatening and requires immediate intervention to redirect urine flow away from the obstructed kidneys [ 3 ].…”

“…However, there are some rare complications associated with these procedures. The outcome of the procedure is influenced by several factors, including the type and degree of obstruction, renal insufficiency, grade of hydronephrosis, systemic treatment after stent implantation, and bladder invasion on cystoscopy [ 1 , 3 ]. In cases of palliative care, medical options are provided, and the patient’s preferences are respected.…”