Selection for percutaneous nephrostomy in gynecologic cancer patients

For patients with gynecologic cancers who present with ureteral obstruction, it is often difficult to determine whether intervention with nephrostomy tube is appropriate. This study was designed to determine if evaluation prior to percutaneous nephrostomy could accurately predict patients who would benefit from intervention. Twenty-two gynecologic cancer patients with bilateral ureteral obstruction were evaluated. Criteria contraindicating intervention included disease progression while on therapy, potentially life-threatening medical problems, Zubrod performance status greater than 2, no available efficacious therapy, noncompliance, and poor pain control. A single criterion was sufficient to contradindicate percutaneous nephrostomy placement. Including replacement nephrostomies, a total of 46 percutaneous nephrostomies and four stents were placed in 19 patients. Three patients had no intervention. Only 9 patients did not have any contradictions to placement of percutaneous nephrostomy, based on predictive criteria. Patients without contraindications to percutaneous nephrostomy survived longer (median days, 242 versus 37; P less than 0.05), had improved quality of life (median days at home, 164 versus 2; P less than 0.05), and had a better chance of receiving therapy after percutaneous nephrostomy (9 versus 2 patients; P less than 0.05). Assessment prior to percutaneous nephrostomy maybe helpful in guiding the physician in recommending intervention.