title: Obstructive uropathy in gynecologic malignancy. Detrimental effect of intraureteral stent placement and value of percutaneous nephrostomy.
abstract: Records of all patients with obstructive uropathy and gynecologic malignancy were reviewed to determine treatment, including indications for dialysis, and outcomes. Over 5 years (July, 1989-June, 1994), 41 patients were identified, 34 of whom (83%) had renal failure or insufficiency with a serum creatinine concentration > or = 1.5 mg/dl. All of those with renal failure had hydronephrosis: bilateral in 28 of 34 patients (82%), and unilateral in the rest (18%). There was no consistent approach to management, which appeared unrelated to staging of cancer, and included unilateral nephrostomy alone (n = 6), bilateral nephrostomy (n = 11), intraureteral stent catheter placement alone (n = 5), a combination of nephrostomy and intraureteral stent catheter placement (n = 3), urinary diversion into an ileal conduit (n = 2), or no treatment (n = 7). Of seven patients who had stent catheter placement, urosepsis developed in six (86%), leading to death in three of seven (43%). Bilateral nephrostomy placement was clearly valuable in reversing renal failure (p = 0.002), and superior to unilateral nephrostomy (p = 0.125), intraureteral stent catheter placement alone (p = 0.75), or a combination of nephrostomy and intraureteral stent catheter placement (p = 1.0). Only 2 of 34 patients with renal failure (6%) were dialyzed. This experience indicates that: 1) intraureteral stent catheter placement predisposes to urosepsis and should be avoided; 2) bilateral nephrostomy placement allows significant improvement in renal function, and is superior to either unilateral nephrostomy placement or combination nephrostomy-stent catheter placement; and 3) dialysis is rarely applied to this population.
authors.affiliation: State University of New York Health Science Center at Brooklyn 11203, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Hyppolite
authors.forename: I D
authors.initials: ID
authors.lastname: Daniels
authors.forename: E A
authors.initials: EA
authors.lastname: Friedman
mesh_terms: D000328:Adult; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications*; D006801:Humans; D009403:Nephrostomy, Percutaneous / Q000379:methods; D051437:Renal Insufficiency / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D014517:Ureteral Obstruction / Q000209:etiology* / Q000628:therapy*; D014552:Urinary Tract Infections / Q000209:etiology