Indications for percutaneous nephrostomy in patients with obstructive uropathy due to malignant urogenital neoplasias.
BACKGROUND
Urogenital neoplasias frequently progress with obstructive uropathy due to local spreading or pelvic metastases. The urinary obstruction must be immediately relieved in order to avoid deterioration in these patients. The percutaneous nephrostomy is a safe and effective method for relief the obstruction; however the indications of such procedures have been questioned in patients with poor prognosis.


METHODS
A retrospective study was performed with 43 patients (29 female and 14 male) with urogenital neoplasias who were undergoing percutaneous nephrostomy during a 54-month period. The median age was 52 years. The primary tumoral site was the uterine cervix in 53.5% of patients, the bladder in 23.3%, the prostate in 11.6% and other sites in 11.6%.


RESULTS
Postoperative complications occurred in 42.3% of the patients. There was no procedure-related mortality. Thirty-nine per cent of the patients died during the hospitalization period due to advanced neoplasia. The mortality rate was higher in patients with prostate cancer (p = 0.006), in patients over 52 years of age (p = 0.03) and in those who required hemodialysis before the procedure (p = 0.02). Thirty-two per cent of the patients survived long enough to undergo some form of treatment focused on the primary tumor. The survival rate was 40% at 6 months and 24.2% at 12 months. The percentage of the lifetime spent in hospitalization was 17.7%. The survival rate was higher in patients with neoplasia of the uterine cervix (p = 0.007) and in patients with 52 years of age or less (p = 0.008).


CONCLUSIONS
Morbidity was high in this patient group; however, the majority of patients could be discharged from hospital and followed at home. Patients under 52 years of age and patients with neoplasia of the uterine cervix benefited most from the percutaneous nephrostomy when compared to patients with hormone therapy-refractory prostate cancer, bladder cancer or over 52 years of age.
Romero
Frederico R
FR
Division of Urology, Medical Sciences School of Santa Casa de Sao Paulo, Sao Paulo, SP, Brazil. fredromero@terra.com.br
Broglio
Marcos
M
Pires
Silvio R
SR
Roca
Roberto F
RF
Guibu
Ione A
IA
Perez
Marjo D
MD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology* / Q000601:surgery*; D014565:Urogenital Neoplasms / Q000150:complications*