Role of percutaneous nephrostomy in improving quality of life in advanced carcinoma cervix presenting with obstructive uropathy

Aims and objectives: Percutaneous nephrostomy (PCN) is an interventional procedure which is mainly used in the decompression of the renal collecting system. Urinary diversion by this procedure can improve renal function. We examined the role of PCN in the management of advanced cervical cancer patients presenting with obstructive uropathy with a detailed analysis of improvement in the quality of life, morbidity, and survival rates. Materials and methods: We prospectively evaluated 50 gynecology patients having cervical cancer with obstructive uropathy and deranged renal functions. A PCN was performed under local anesthesia using the Seldinger technique. Positions of catheters were confirmed with the nephrostogram at the end of the procedures. Health survey was conducted before the PCN procedure, 1st week, and 4th week and at the 3rd month after the PCN procedure. Results: PCN was successfully established in all patients with the recovery of renal function. The median serum creatinine before and 1 month after the procedure was 6.6 and 2.0, respectively. Complications relating to the procedure (60%) were fever/sepsis 7 (14%), bleeding in 5 (10%), pericatheter leak in 10 (20%), and slippage of catheter requiring replacement in 7 (14%). Overall, 45 (90%) patients died of the primary disease and 5 are alive. The 3, 6, 9, and 12 months’ death rates were 8 (16%), 15 (30%), 21 (42%), and 2 (1%), respectively. Fifty percent of death occurred within 6 months and 90% of death occurred by 9 months. Conclusion: PCN provides a significant improvement in renal function parameters in majority of the patients. The quality of life is improved significantly at 1 week and 1 month which is not sustained at 3 months. As the benefits of PCN urinary diversion after 3 months are not established, counseling is essential and the wishes of the patient and her family have to be considered.