title: Percutaneous nephrostomy in the management of advanced and terminal-stage gynecologic malignancies: outcome and complications.
abstract: OBJECTIVE
  The goal of the study was to evaluate the outcome and complications after percutaneous nephrostomy (PCN) insertion in advanced and terminal-stage gynecological malignancies with ureteral obstruction (UO).
  
  
  METHODS
  We analyzed data of 117 patients with UO due to gynecological malignancies, who had undergone PCN between 1996 and 2006. Cervical cancer was evidenced in 108 patients, uterine carcinoma in six and ovarian cancer in three patients. Eighty-nine had UO at the initial manifestation of the disease, 22 had persistent or recurrent cancer, and six were disease-free after initial therapy. Oliguria was observed in 22.2% and creatine elevation in 79.5%. Mean follow-up was 11.43 months (range 0-112).
  
  
  RESULTS
  The median age was 51 years (range 28-85). Bilateral nephrostomy was performed in 36.7% and unilateral in 63.3%. Renal function normalization occurred in 24.8%. Overall two-year survival (OS) was 16.8%. Higher OS occurred in patients without initial azotemia versus those with azotemia (26.8% vs 13.9%). Median survival time for all the patients was seven months, eight in primary cases versus six in recurrent ones, and eight months in patients after initial therapy. Complications appeared in 53.85%. Most frequent were the loss of the nephrostomy catheter in 37.61% and urinary tract infections in 19.6%.
  
  
  CONCLUSIONS
  Improvement of renal function after PCN can be of clinical benefit in patients who might be cured or for prolonged palliative care. Azotemia seems to be poor prognostic sign.
authors.affiliation: Department of Radiotherapy, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia. plesinacvesna@yahoo.com
authors.forename: V
authors.initials: V
authors.lastname: Plesinac-Karapandzic
authors.forename: D
authors.initials: D
authors.lastname: Masulovic
authors.forename: B
authors.initials: B
authors.lastname: Markovic
authors.forename: A
authors.initials: A
authors.lastname: Djuric-Stefanovic
authors.forename: S
authors.initials: S
authors.lastname: Plesinac
authors.forename: D
authors.initials: D
authors.lastname: Vucicevic
authors.forename: Z
authors.initials: Z
authors.lastname: Milovanovic
authors.forename: Z
authors.initials: Z
authors.lastname: Milosevic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053099:Azotemia / Q000209:etiology; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects* / Q000379:methods*; D010051:Ovarian Neoplasms / Q000150:complications / Q000473:pathology; D010166:Palliative Care / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000473:pathology; D055815:Young Adult