title: A qualitative study exploring male cancer patients' experiences with percutaneous nephrostomy.
abstract: OBJECTIVE
  Obstructive uropathy due to advanced cancer can be efficiently treated with a percutaneous nephrostomy. The treatment is associated with complications and frequent readmissions. How the patients' quality of life is affected by a nephrostomy remains uncertain. The aim of this study was to describe how a nephrostomy is perceived by patients and its effects on their everyday lives.
  
  
  METHODS
  Semi-structured interviews were conducted in the patients' home using a mind map. The inclusion criteria were locally advanced or metastatic urological cancer treated with a nephrostomy for a minimum of 1 month. All interviews were audio recorded, transcribed and analysed using a grounded theory approach. Ten male patients were interviewed, eight with prostate cancer and two with bladder cancer.
  
  
  RESULTS
  Treatment with nephrostomy influenced the physical activity level and restricted normal social activities. Readmissions had a negative influence on mood. However, the patients who experienced symptom improvement were thankful for having had the nephrostomy, despite the inconveniences. Communicating about the hazards and benefits helped patients to adjust their expectations of a nephrostomy.
  
  
  CONCLUSIONS
  The study describes how nephrostomy is a burdensome intervention accompanied by a plethora of complex physical and psychosocial issues. Having a nephrostomy on a palliative indication has extensive implications for the patients, which should not be neglected or underestimated. Individual assessment of each patient, together with excellent communication regarding the procedure and outcome, is essential. Most patients had frequent contact with the healthcare system and additional support could be offered by a palliative care service.
authors.affiliation: Department of Urology, Herlev Hospital , Denmark.
authors.forename: Lene Hyldgaard
authors.initials: LH
authors.lastname: Bigum
authors.forename: Marlène Elisabeth
authors.initials: ME
authors.lastname: Spielmann
authors.forename: Gitte
authors.initials: G
authors.lastname: Juhl
authors.forename: Annlise
authors.initials: A
authors.lastname: Rasmussen
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009403:Nephrostomy, Percutaneous / Q000523:psychology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D011584:Psychology; D011788:Quality of Life / Q000523:psychology; D058992:Social Participation / Q000523:psychology; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology*; D014571:Urologic Neoplasms / Q000523:psychology / Q000556:secondary* / Q000601:surgery*
keywords: cancer; hydronephrosis; malignant ureter obstruction; nephrostomy; qualitative research; urinary diversion