The optimal management of patients with ureteric obstruction in advanced malignancy is unclear. How quality of life is affected by a nephrostomy and how many of these patients undergo further oncological treatment remains uncertain.
The objective of this retrospective multicentre study was to look at the outcomes of patients who had percutaneous nephrostomy insertion for malignancy.
We identified patients who had a nephrostomy inserted for ureteric obstruction due to malignancy at our institution from January 2015 to December 2018. We obtained data retrospectively from our electronic patient record system. Patients who had nephrostomy insertion for other causes such as ureteric calculi or injury were excluded from the study.
105 patients underwent nephrostomy insertion during this time interval. 51.42% patients (n = 54) had urological malignancies (bladder and/or prostate cancer). The median LOS was 14 days (range 1-104 days) post-procedure and 39.04% (n = 41) had at least one 30-day readmission to hospital. The average starting creatinine level was 348 mmol/L (range 49-1133) and the average creatinine at discharge was 170 mmol/L (range 44-651). Although the average change in the creatinine (190 mmol/L) is statistically significant (p < 0.001), it did not seem to prolong life of the patients. Only 26 (24.76%) patients were alive (all-cause mortality) at the end of the 4-year period with an average life expectancy of 139 days following nephrostomy. Only 30.47% (n = 32) patients underwent further oncological treatment.
In our series, most patients who had nephrostomy insertion for ureteric obstruction due to malignancy had no further oncological treatment following insertion. Percutaneous nephrostomy is a procedure not without associated morbidity and does not always prolong survival. Due to the poor prognosis in cases of advanced malignancy, we advocate multi-disciplinary decision-making prior to nephrostomy insertion.
International urology and nephrology. 2020 Apr 22 [Epub ahead of print]
Samuel Stephen Folkard, Srijit Banerjee, Richard Menzies-Wilson, Joseph Reason, Evangelos Psallidas, Elliot Clissold, Ahmad Al-Mushatat, Saurabh Chaudhri, James Stephen Arthur Green
Department of Urology, Whipps Cross Hospital, Whipps Cross Rd., Leytonstone, London, E11 1NR, UK. ., Department of Urology, Royal London Hospital, Whitechapel Rd., Whitechapel, London, E1 1FR, UK., Department of Urology, Whipps Cross Hospital, Whipps Cross Rd., Leytonstone, London, E11 1NR, UK., Department of Nephrology, Whipps Cross Hospital, Whipps Cross Rd., Leytonstone, London, E11 1NR, UK.