URINARY-TRACT OBSTRUCTION AND NEPHROSTOMY DRAINAGE IN PELVIC MALIGNANT DISEASE

Objective To determine the survival of patients after percutanous neph rostomy drainage (PND) for obstructive uropathy secondary to pelvic ma lignant disease.Patients and methods The records of 77 patients underg oing PND for obstructive uropathy were reviewed. Patients were classif ied according to the nature of the obstructing lesion: Group I (primar y untreated malignancy, 31 patients); Group II (recurrent malignancy w ith further treatment, 15 patients); Group III (recurrent malignancy w ith no further treatment, 12 patients); and Group TV (benign disease a s a consequence of previous treatment, 19 patients). Outcome was asses sed by survival over a mean follow-up of 20 months (range 2 days-8.3 y ears). Results Overall median survival was 26 weeks, with a 5-year sur vival of 22%. The survival in Groups I and II was not significantly di fferent (median survival 27 and 20 weeks, respectively; 5-year surviva l, 10% and 20%, respectively). Group III patients had a poor prognosis (median survival 6.5 weeks) with no patient surviving beyond one year , whilst Group TV patients fared best with a 5-year survival of 64%. T he commonest primary tumour type was carcinoma of the cervix (42 patie nts), and these patients were analysed as a subset. Benign post-radiat ion fibrosis was found in 16 of 27 patients (59%). Survival was relate d to the diagnostic group. Conclusion The nature and extent of the obs tructing lesion and its potential for further treatment are the major determinants of post-nephrostomy survival. Every effort should therefo re be made to identify the nature of the obstruction before deciding o n PND.