Role of percutaneous nephrostomy in advanced cervical carcinoma with obstructive uropathy: A case series

Abstract

Aims and Objective:Over 70% of the cases present in advanced stages of the disease and are associated with poor prognosis and high mortality rates. In many of them, it is difficult to offer definitive treatment as they present in uremia due to associated obstructive uropathy. There are no clear-cut guidelines for performing percutaneous nephrostomy (PCN) in patients of advanced cervical cancer. The results are unpredictable in terms of benefits achieved in these cases. Thus, we evaluated our experiences with PCN in the management of cervical cancer patients presenting with obstructive uropathy.Material and Methods:15 patients of cervical cancer with obstructive uropathy and deranged renal functions were retrospectively evaluated for the role of PCN in their managementResults:PCN was done in 15 patients of advanced cervical cancer. The mean age of patients was 44.5 years. Twelve (80%) patients presented primarily with advanced cervical carcinoma and obstructive uropathy. Three (20%) were already treated. Symptomatic improvement and significant fall of mean serum creatinine value from 7.5 mg% to 0.9 mg% over a period of 1-3 weeks was noted post PCN. Out of 12 patient with primary untreated advanced disease, curative treatment was possible in 3, palliative radiotherapy/chemo-therapy in 7 and only symptomatic treatment in 2 cases, after obstructive uropathy was managed with PCN insertion. Out of 3 already treated patients, 2 were disease free after curative radiotherapy/surgery. PCN was done to prevent permanent kidney damage in them. One patient was defaulter of curative radiotherapy. She had progressive residual disease. Complications like hemorrhage (20%), infection (26%), reinsertion for dislodgment/misplacement (53%), percutaneous leak or perinephric leak (20%), blockage of PCN (33%) were noticed.Conclusion:In spite of inherent, albeit manageable complications, PCN is a simple and safe technique. One of the major benefits observed was ability to administer either curative/palliative radiotherapy or chemotherapy in 85% of patients (11 out of 13 with disease). There was no active disease in remaining 2 patients. Therefore, the decision to attempt PCN in carefully selected cervical cancer patients is justified.

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

“…This finding is consistent with previous study undergoing palliative urinary diversion for ureteric obstruction in patients having gynaecological malignancy along with symptomatic improvement over a period of 1-3 weeks post PCN [17][18][19]. These studies confirm that urinary diversion can cause rapid restoration of renal function and evasion of the complications of uraemia.…”

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“…This finding is consistent with previous study undergoing palliative urinary diversion for ureteric obstruction in patients having gynaecological malignancy along with symptomatic improvement over a period of 1-3weeks post PCN. [17][18][19] These studies confirm that urinary diversion can cause rapid restoration of renal function and evasion of the complications of uraemia. PCN also caused lower complication rates therefore, is superior to intraureteral stenting.…”

Effect of percutaneous nephrostomy in late stage cervical cancer’s survival with impaired renal function

“…Mishra et al reported that the average 5-year survival of cervical cancer patients without urethral obstruction and normal kidney function was 47%, whereas if there is obstruction of the ureter the survival was 29%. 5 Kidney failure in cervical cancer is mostly (90%) caused by high location of the obstruction in the ureter due to compression of the tumor mass. Cervical cancer can spread to surrounding structures including a lower segment of the uterus, vagina, paracervical and parametrial spaces.…”