Outcome analysis of percutaneous nephrostomy insertion to relieve urinary obstruction in advanced malignancy.

Abstract

Objective: The aim is to evaluate the benefits of percutaneous nephrostomy (PCN) for urinary drainage in patients with malignancy-associated urinary obstruction (MUO). This study examines the impact of PCN on immediate renal recovery, procedural morbidity, short-term outcomes, and patient survival.

Methods: A total of 477 patients with ureteric obstruction underwent PCN placement, of whom one-third had MUO. Demographic and clinical parameters were reviewed to assess renal outcomes, complication rates, hospital stay, and overall survival.

Results: Nearly two-thirds of the patients with MUO had a primary urological malignancy (bladder cancer 30% and prostate cancer 25%). The mean hospital stay was <7 weeks, with patients with gynecological malignancies experiencing the shortest admissions. During the study period, 59 (37%) patients died. The overall median survival was 107 weeks, with the shortest survival observed in patients with primary colorectal cancer (median 34 weeks). Patients with primary bladder and prostate malignancies demonstrated higher median survival compared to other malignancies.

Conclusion: MUO often represents advanced disease in colorectal and gynecological cancers. PCN can be beneficial for selected patients who are candidates for further oncological treatment. However, it should be considered only after careful discussion regarding the potential need for long-term nephrostomy, procedural morbidity, and quality-of-life impact. Although PCN achieved high rates of renal function recovery and had low complication rates (12%-17%), the underlying malignancy and associated social factors contributed to prolonged hospital stays, sometimes accounting for up to one-third of a patient's remaining life.