Impact of percutaneous nephrostomy on clinical outcomes in advanced carcinoma cervix with obstructive uropathy at Kenyatta national hospital

Abstract

This retrospective study aimed to determine the impact of percutaneous nephrostomy (PCN) on the quality of life (QOL) and kidney function of women with advanced carcinoma of the cervix and obstructive uropathy in Kenyatta National Hospital by utilizing data from 2016 to 2019 and a follow-up patient interview in 2020. Sociodemographic data from patient records was reported as descriptive statistics. Serum urea, hemoglobin and creatinine levels before PCN and 72 hours, 1 month and 3 months after PCN were obtained. The changes were analysed using a paired t-test. Quality of life data before and after PCN tube insertion were collected using the structured Functional Assessment of Cancer Therapy and a cervix cancer-specific subscale (FACT-Cx) questionnaire, responses scored and an aggregate tallied. The QOL and kidney function data variables before and after PCN tube insertion were compared with statistical significance set at p < 0.05. Fifty eight study participants were enrolled, with an 80% power to detect a 5 fold change in kidney function. Percutaneous nephrostomy had an overall improvement in the quality of life (FACT-Cx total p = 0.041) with changes in aspects of physical well-being (p = 0.018) and additional concerns sexual function, self-esteem, appearance, urinary function, appetite and gastrointestinal function (p ≤ 0.001); but none in other aspects of the tool. Improvement was noted 72 hours after PCN tube insertion in 62% of patients’ urea (p = 0.033) and 64% of creatinine (p ≤ 0.001) levels but not sustained after 1 month and did not revert to normal levels. Hemoglobin levels did not improve. Percutaneous nephrostomy was found to have a short-term added value in management of women with obstructed uropathy in advanced carcinoma of the cervix as two aspects of their QOL improved while serum urea and creatinine levels improved slightly with no functional recovery.