Predicting factors for improvement of serum creatinine after percutaneous nephrostomy in adults with bilateral hydronephrosis associated with malignancy

  • Sekdusit Aekgawong Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Patkawat Ramart Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Keywords: Bilateral hydronephrosis, percutaneous nephrostomy, serum creatinine, renal function

Abstract

Objective: Improvement of renal function in obstructive uropathy is a main goal of urinary diversion. In cases of failed internal diversion, percutaneous nephrostomy (PCN) is used to divert urine from the obstructed kidney. PCN also affect on quality of life, particularly having both sides. The objective of this study was to identify a predicting factor associated with improvement of renal function after bilateral PCNs and to avoid performing bilateral PCNs.

Materials and Methods: Data of all patients with bilateral hydronephrosis associated with malignancy who were performed bilateral PCNs in Siriraj Hospital between December 2011 and December 2016 were reviewed and collected. Success with PCN was defined as a serum creatinine less than 2 mg/dl or decreased more than 95% of initial serum creatinine.

Results: A total of 240 patients met the criteria. Mean age was 64.6 ± 14.9 years old. Most common organ of malignancy was cervix. Mean initial serum creatinine (iCr) and nadir serum creatinine (nCr) were 7.7 and 1.9 mg/dl, respectively. On multivariate analysis, no significant predicting factors were demonstrated but only iCr tended to have a statistically significant (p = 0.058). From receiver operating characteristics analysis, at cut-off value of iCr 5 mg/dl could demonstrate significant difference between success and failure (p = 0.027). Sensitivity and specificity were 72.4% and 44.0%, respectively.

Conclusion: Only the iCr was more likely to be a predicting factor. At cut-off value of iCr 5 mg/dl, if a patient presented with iCr more than 5 mg/dl and unilateral PCN at dominant side did not improve serum creatinine, performing contralateral PCN might not help.

Downloads

Download data is not yet available.

References

Siddiqui MM, McDougal WS. Urologic assessment of decreasing renal function. Med Clin North Am 2011;95:161-8.

Feng MI, Bellman GC, Shapiro CE. Management of ureteral obstruction secondary to pelvic malignancies. J Endourol 1999;13:521-4.

Sharer W, Grayhack JT, Graham J. Palliative urinary diversion for malignant ureteral obstruction. J Urol 1978;120:162-4.

Kouba E, Wallen EM, Pruthi RS. Management of ureteral obstruction due to advanced malignancy: optimizing therapeutic and palliative outcomes. J Urol 2008;180:444-50.

Friedlander JI, Duty BD, Okeke Z, Smith AD. Obstructive uropathy from locally advanced and metastatic prostate cancer: an old problem with new therapies. J Endourol 2012;26:102-9.

Nariculam J, Murphy DG, Jenner C, Sellars N, Gwyther S, Gordon SG, et al. Nephrostomy insertion for patients with bilateral ureteric obstruction caused by prostate cancer. Br J Radiol 2009;82:571-6.

Radecka E, Magnusson A. Complications associated with percutaneous nephrostomies. A retrospective study. Acta Radiol 2004;45:184-8.

Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 1993;23:478-80.

Hyppolite JC, Daniels ID, Friedman EA. Obstructive uropathy in gynecologic malignancy. Detrimental effect of intraureteral stent placement and value of percutaneous nephrostomy. ASAIO J 1995;41:M318-23.

Ito K, Chen J, El Chaar M, Stern JM, Seshan SV, Khodadadian JJ, et al. Renal damage progresses despite improvement of renal function after relief of unilateral ureteral obstruction in adult rats. Am J Physiol Renal Physiol 2004;287:F1283-93.

Lucarelli G, Ditonno P, Bettocchi C, Grandaliano G, Gesualdo L, Selvaggi FP, et al. Delayed relief of ureteral obstruction is implicated in the long-term development of renal damage and arterial hypertension in patients with unilateral ureteral injury. J Urol 2013;189:960-5.

Shokeir AA, Shoma AM, Abubieh EA, Nasser MA, Eassa W, El-Asmy A. Recoverability of renal function after relief of acute complete ureteral obstruction: clinical prospective study of the role of renal resistive index. Urology 2002;59:506-10.

Thompson A, Gough DC. The use of renal scintigraphy in assessing the potential for recovery in the obstructed renal tract in children. BJU Int 2001;87:853-6.

Published
2021-06-01
How to Cite
Aekgawong, S., & Ramart, P. (2021). Predicting factors for improvement of serum creatinine after percutaneous nephrostomy in adults with bilateral hydronephrosis associated with malignancy. Insight Urology, 42(1), 1-6. https://doi.org/10.52786/isu.a.15
Section
Original article

Most read articles by the same author(s)