Obstructive Uropathy in Gynecologic Malignancy

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Abstract
Records of all patients with obstructive uropathy and gynecologic malignancy were reviewed to determine treatment, including indications for dialysis, and outcomes. Over 5 years (July, 1989–June, 1994), 41 patients were identified, 34 of whom (83%) had renal failure or insufficiency with a serum creatinine concentration ≥ 1.5 mg/dl. All of those with renal failure had hydronephrosis: bilateral in 28 of 34 patients (82%), and unilateral in the rest (18%). There was no consistent approach to management, which appeared unrelated to staging of cancer, and included unilateral nephrostomy alone (n = 6), bilateral nephrostomy (n = 11), intraureteral stent catheter placement alone (n = 5), a combination of nephrostomy and intraureteral stent catheter placement (n = 3), urinary diversion into an ileal conduit (n = 2), or no treatment (n = 7). Of seven patients who had stent catheter placement, urosepsis developed in six (86%), leading to death in three of seven (43%). Bilateral nephrostomy placement was clearly valuable in reversing renal failure (p = 0.002), and superior to unilateral nephrostomy (p = 0.125), intraureteral stent catheter placement alone (p = 0.75), or a combination of nephrostomy and intraureteral stent catheter placement (p = 1.0). Only 2 of 34 patients with renal failure (6%) were dialyzed. This experience indicates that: 1) intraureteral stent catheter placement predisposes to urosepsis and should be avoided; 2) bilateral nephrostomy placement allows significant improvement in renal function, and is superior to either unilateral nephrostomy placement or combination nephrostomy–stent catheter placement; and 3) dialysis is rarely applied to this population.

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