Presented by: Sharon Fihsberg MD
Hadassah Medical Center and The Hebrew University of Jerusalem

Introduction

Malignant ureteric obstruction (MUO) is common in patients with advanced malignancy and percutaneous nephrostomy (PCN) is its ultimate solution. Yet PCN insertion is painful and living with PCN is marked by a decrease in quality of life, and frequent complications. Urologists and oncologists were often blamed for overusing this procedure potentially violating the core ethical principle of nonmaleficence. In this study, based on a three-month survival threshold, we attempted to find whether PCN is justified in current patients with MUO.

Materials

The study analyzed data of 34 patients treated with PCN for MUO. Information regarding the indication for PCN and the survival after PCN insertion was collected.   

Results

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Average patients age was 64.17 years( ±15.81). The etiology of the obstruction was: urothelial carcinoma in 13 patients, prostate cancer in 7 patients, colorectal cancer in 6 patients, and other malignancies in 8 patients. The indications for PCN: were acute renal failure in 29 patients (79.4%), infection in 10 patients (29.4%), pain in 3 patients (8.8%), and hydronephrosis in 3 patients (8.8%). Out of the 34 patients, 26 patients (76.5%) met the three months survival  threshold. The average survival after PCN insertion was 391 days ( ±479.4), demonstrating the long-term beneficial effect of this intervention.

Conclusion

PCN is an effective palliative intervention for patients with MUO. Currently inserted PCNs are done almost always for good reasons (renal failure, infection, and pain) and not for the management of hydronephrosis and most patients meet the three-month survival threshold.

Funding

No funding was recieved for this work

Co-Authors

Conor Brown, MD
Hadassah Medical Center and The Hebrew University of Jerusalem

Vladimir Yutkin, MD
Hadassah Medical Center and The Hebrew University of Jerusalem

Mordechai Duvdevani, MD
Hadassah Medical Center and The Hebrew University of Jerusalem

Amitay Lorber, MD
Hadassah Medical Center and The Hebrew University of Jerusalem

Guy Hidas, MD
Hadassah Medical Center and The Hebrew University of Jerusalem

Ofer Gofrit, MD PHD
Hadassah Medical Center and The Hebrew University of Jerusalem