Quality-of-Life Assessment After Palliative Interventions to Manage Malignant Ureteral Obstruction

Abstract

Purpose Malignancies may cause urinary tract obstruction, which is often relieved with placement of a percutaneous nephrostomy tube, an internal double J nephro-ureteric stent (double J), or an internal external nephroureteral stent (NUS). We evaluated the affect of these palliative interventions on quality of life (QoL) using previously validated surveys. Methods Forty-six patients with malignancy related ureteral obstruction received nephrostomy tubes (n = 16), double J stents (n = 15), or NUS (n = 15) as determined by a multidisciplinary team. QoL surveys were administered at 7, 30, and 90 days after the palliative procedure to evaluate symptoms and physical, social, functional, and emotional well-being. Number of related procedures, fluoroscopy time, and complications were documented. Kruskal–Wallis and Friedman’s test were used to compare patients at 7, 30, and 90 days. Spearman’s rank correlation coefficient was used to assess correlations between clinical outcomes/symptoms and QoL. Results Responses to QoL surveys were not significantly different for patients receiving nephrostomies, double J stents, or NUS at 7, 30, or 90 days. At 30 and 90 days there were significantly higher reported urinary symptoms and pain in those receiving double J stents compared with nephrostomies (P = 0.0035 and P = 0.0189, respectively). Significantly greater fluoroscopy time was needed for double J stent–related procedures (P = 0.0054). Nephrostomy tubes were associated with more frequent minor complications requiring additional changes. Conclusion QoL was not significantly different. However, a greater incidence of pain in those receiving double J stents and more frequent tube changes in those with nephrostomy tubes should be considered when choosing palliative approaches.

A qualitative study exploring male cancer patients’ experiences with percutaneous nephrostomy

“…The discussion concerning PNT versus JJ stents is ongoing. A recent study measuring quality of life three times, after a PNT, JJ stent or internal-external nephroureteral stent placement, showed no significant differences, but the group with a PNT required more frequent tube changes [18]. The present patients described tube changesscheduled or acutelyas a feared situation owing to discomfort, pain and insecurity.…”

Ureteral obstruction in cancer patients: a qualitative study

“…The purpose of this study was to examine the impact of ureteral obstruction, urinary stent or diversion procedures, and the aftermath of the foregoing on quality of life-as voiced directly by patients. Findings were unexpected, particularly in view of previous studies that have not consistently captured major, questionnaire-derived, negative quality of life findings [3][4][5]. We observed that over two-thirds of the patients we interviewed described the aftermath of a urinary stenting or diverting procedure as highly symptom-laden.…”

Unexpected Extremely High Level of Creatinine in Non-dialysed Female Patient

“…The finding of ureteral obstruction due to malignancy carries a poor prognosis with a resulting median survival of 3 to 7 months, and confers a worse overall prognosis [4,6]. Relief of obstruction is usually achieved by placement of a percutaneous nephrostomy tube, an internalized double J nephroureteral stent, or an internal/external nephroureteral stent (NUS) [7]. Our patient had rejected suggested bilateral percutaneous nephrostomy as modality of decompression and accepted life saving dialysis.…”