Percutaneous urinary diversion in gynecologic oncology

Area of Science:

• Urology
• Gynecologic Oncology
• Nephrology

Background:

• Ureteral obstruction is a common complication in advanced gynecologic cancers.
• Elevated serum creatinine and urea indicate impaired renal function.
• Percutaneous urinary diversion (PCUD) is a potential intervention for managing such complications.

Purpose of the Study:

• To evaluate the efficacy of PCUD in patients with gynecologic malignancies and ureteric obstruction.
• To assess the impact of PCUD on renal function markers (creatinine and urea).
• To analyze survival outcomes and identify factors influencing prognosis after PCUD.

Main Methods:

• A retrospective analysis of 35 patients undergoing PCUD between 1979 and 1989.
• Patients had various stages of cervical, endometrial, or vaginal cancer with radiological evidence of ureteric obstruction.
• Assessment of pre- and post-diversion serum creatinine and urea levels, complication rates, and survival data.

Main Results:

• PCUD led to a significant reduction in mean serum creatinine (482 to 131 μmol/L) and urea (22.0 to 11.9 mmol/L) levels (P < 0.0001 and P < 0.001, respectively).
• Median survival was 6 months post-PCUD, with significantly longer survival for patients with normal pretreatment renal function (16 months) compared to those with elevated levels (2.5 months).
• Minor complications included hemorrhage, infection, and blockage; PCUD facilitated primary therapy in untreated patients.

Conclusions:

• PCUD is an effective procedure for improving renal function in gynecologic cancer patients with ureteric obstruction.
• It is indicated for untreated patients to allow for primary cancer treatment.
• The role of PCUD in previously treated patients should be individualized, considering palliative benefits and symptom control.