Role of percutaneous nephrostomy (PCN) in malignant ureteral obstruction

To assess whether PCN placement in patients having malignant ureteric obstruction can provide patient benefit or increase morbidity.

A prospective study was conducted in the department of Urology CMCH Larkana from 1st January 2004 to December 2006. Patients having malignant ureteric obstruction admitted in our department either directly or referred from other departments with deranged renal functions and in whom retrograde ureteria catheterization had failed, were included. PCN was placed by the standard technique.

A total forty (40) patients fulfilled the criteria for initial PCN placement for their malignant ureteral obstruction. There were 20 males and 20 females with an age range from 21 to 70 years. Of the 40 patients 17 (42.5%) presented directly in this department, with 10 (25%) having anuria and 7 (17.2%) with symptoms of uraemia. Among them ten patients were already diagnosed cases, and seven were diagnosed in our ward. The remaining 23 patients (57.5%) were referred by other departments and were diagnosed cases of malignancy. It was from this study that patients having early or urogenital malignancies benefited from the PCN placement while patients with advanced malignancies and nonurogenital malignancies showed poor response. The median survival in urogenital malignancies was about 350 days (range was 150-700 days), and in non urogenital malignancies except lymphoma it was about 25 days. (Range was 7-80 days). Loss of nephrostomy catheter was the most frequent complication observed in this series.

PCN is an excellent initial procedure for relieving the malignant urinary obstruction with minimal complications. It was concluded from this study that patients having early or urogenital malignancies benefit from PCN placement while patients who have advanced malignancy or non-urogenital malignancies showed poor response. Also patients treated for primary neoplasia that can still be treated with other therapeutic modalities especially radiotherapy, chemotherapy and hormone therapy can also benefit from the procedure.