title: Quality-of-life assessment after palliative interventions to manage malignant ureteral obstruction.
abstract: OBJECTIVE
  Malignancies may cause urinary tract obstruction, which is often relieved with placement of a percutaneous nephrostomy tube, an internal double J nephro-ureteric stent (double J), or an internal external nephroureteral stent (NUS). We evaluated the affect of these palliative interventions on quality of life (QoL) using previously validated surveys.
  
  
  METHODS
  Forty-six patients with malignancy related ureteral obstruction received nephrostomy tubes (n = 16), double J stents (n = 15), or NUS (n = 15) as determined by a multidisciplinary team. QoL surveys were administered at 7, 30, and 90 days after the palliative procedure to evaluate symptoms and physical, social, functional, and emotional well-being. Number of related procedures, fluoroscopy time, and complications were documented. Kruskal-Wallis and Friedman's test were used to compare patients at 7, 30, and 90 days. Spearman's rank correlation coefficient was used to assess correlations between clinical outcomes/symptoms and QoL.
  
  
  RESULTS
  Responses to QoL surveys were not significantly different for patients receiving nephrostomies, double J stents, or NUS at 7, 30, or 90 days. At 30 and 90 days there were significantly higher reported urinary symptoms and pain in those receiving double J stents compared with nephrostomies (P = 0.0035 and P = 0.0189, respectively). Significantly greater fluoroscopy time was needed for double J stent-related procedures (P = 0.0054). Nephrostomy tubes were associated with more frequent minor complications requiring additional changes.
  
  
  CONCLUSIONS
  QoL was not significantly different. However, a greater incidence of pain in those receiving double J stents and more frequent tube changes in those with nephrostomy tubes should be considered when choosing palliative approaches.
authors: Department of Radiology, University of Washington Medical Center, 1959 Pacific Ave NE, Box 357115, Seattle, WA, 98195, USA, wemonsky@msn.com.
authors: Wayne Laurence
authors: WL
authors: Monsky
authors: Chris
authors: C
authors: Molloy
authors: Bedro
authors: B
authors: Jin
authors: Timothy
authors: T
authors: Nolan
authors: Dayantha
authors: D
authors: Fernando
authors: Shaun
authors: S
authors: Loh
authors: Chin-Shang
authors: CS
authors: Li
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological / Q000502:physiology; D001294:Attitude to Health; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000706:statistics & numerical data; D010146:Pain / Q000209:etiology / Q000523:psychology; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014517:Ureteral Obstruction / Q000523:psychology* / Q000601:surgery
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