UBC Theses and Dissertations
Percutaneous nephrostomy versus retrograde ureteral stent in adult patients with malignant ureteral obstruction : comparing changes in the renal function and clinical outcomes Eshumani, Walid
Background: Urinary diversion (UD) in malignant ureteral obstruction (MUO) is required to relieve symptoms, initiate systemic therapies, and save lives, especially in bilateral ureteral obstruction. Percutaneous nephrostomy (PCN) and retrograde ureteral stent (RUS) are the most common interventional methods. However, these interventional methods' success, efficacy, and complication rates vary. Methods: Clinical outcomes and changes in renal function following UD in patients with MUO treated at Vancouver General Hospital (VGH) from January 2015 to October 2021 were analyzed retrospectively. A total of 159 patients were identified, of whom 81 underwent PCN (38 males (46%) and 43 females (53%), mean age ± SD 65.7± 12.9 years, range 35 to 95 years) and 78 underwent RUS insertion (27 males (35%) and 51 females (65%), mean age 66.4 ± 13.1 years, range 24 to 90 years). Renal function changes were compared between the two groups using serum creatinine and estimated glomerular filtration rate (eGFR) data at baseline, at intervention, and at different time points after intervention (1 week and 1,3,6, and 12 months). Clinical endpoints assessed included the success rate of UD, procedural complications, and the need for another UD method. Results: The renal function was comparable between the two study arms except at the time of the intervention, in which the PCN median creatinine was 290 vs 127 in the RUS (p <0.001) and median eGFR 17 vs 44 (p<0.001). The success rate of intervention was high in both groups and there was no statistically significant difference (97.9% in the PCN group and 93.5% in RUS group (p=0.104)). Compared to the PCN group, the RUS group had a higher rate of residual hydronephrosis following intervention (55% vs 17%, p <0.001), however, residual hydronephrosis was not associated with serum creatinine levels (correlation coefficient 0.075, p=0.419). Complications in the two groups were comparable (PCN 50.6% vs RUS 50%, p=0.367). The median overall survival for all MUO patients was 12.1 months. It was 11.4 months in the PCN group and 13.3 months in the RUS group (p=0.480). Conclusion: PCN and RUS are safe and effective UD methods for decompressing kidneys affected by MUO.
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