Urinary diversion in children with pelvic tumors
1Department of General Surgery, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Insights
Urgent upper urinary tract diversion is crucial for children with malignant pelvic tumors. This intervention allows for timely chemotherapy initiation, improving outcomes for pediatric cancer patients.
Area of Science:
- Pediatric Oncology
- Urologic Oncology
- Pediatric Surgery
Background:
- Malignant pelvic tumors in children can cause upper urinary tract obstruction.
- Obstruction necessitates prompt management to prevent renal damage and facilitate systemic treatment.
Purpose of the Study:
- To investigate the outcomes of children with malignant pelvic tumors obstructing the upper urinary tract.
- To evaluate the effectiveness of upper urinary tract diversion in this pediatric population.
Main Methods:
- Retrospective review of 17 children with malignant pelvic tumors causing upper urinary tract obstruction.
- Management involved nephrostomy tubes or Double J (DJ) stents for urinary diversion.
- Diversion devices were removed after tumor shrinkage or hydronephrosis regression.
Main Results:
- Rhabdomyosarcoma was the most frequent obstructing tumor.
- Nephrostomy tubes were used in 12 children, DJ stents in 3, and 2 underwent ureteroureterostomy.
- Complications included febrile urinary tract infections (UTI) and device malfunctions; 9 patients achieved no evidence of disease, while 6 died.
Conclusions:
- Optimal and urgent upper tract diversion is essential for children with malignant pelvic tumors.
- Effective diversion facilitates the immediate commencement of chemotherapy, impacting prognosis.
Purpose:
The aim of this study was to investigate children presenting with malignant pelvic tumors obstructing the upper urinary tract.
Methods:
Seventeen children with upper urinary tract obstruction by a malignant tumor were reviewed. A nephrostomy tube or Double J (DJ) stent was inserted into each obstructed urinary system and removed after tumor shrinkage and/or hydronephrosis regression.
Results:
There were 9 boys and 8 girls in the study; the mean age and median follow-up were 5.7 years and 2.5 years, respectively. The most common obstructing tumor was rhabdomyosarcoma. Twelve children underwent diversion by nephrostomy tubes and 3 by DJ stents; 2 patients underwent resection of the tumors with ureteroureterostomy. Complications after the insertion of the stents included febrile urinary tract infections (UTI) or pyelonephritis in 4 of the children with DJ stents. In the nephrostomy group, febrile UTI developed in 3 and the tube fell out in 1, and was blocked in another. Of the 17 children, 9 have no evidence of disease, 2 are currently under treatment, and 6 died of cancer.
Conclusions:
The prognosis of children with malignant pelvic tumor obstructing the upper urinary system justifies urgent and optimal upper tract diversion, enabling chemotherapy to be started immediately.
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