Palliative management of bilateral malignant ureteric obstruction

Abstract

Background Malignant ureteric obstruction is often associated with end-stage cancer arising from the cervix, bladder, prostate and other pelvic organs. We reviewed palliative therapeutic options and outcome of patients with bilateral malignant ureteric obstruction at the Jos University Teaching Hospital (JUTH). Methods This was a retrospective cross-sectional study. Data from patients managed by the Urology division of JUTH for patients with bilateral ureteric obstruction of malignant cause over a period of 10 years were reviewed. Patients’ age, cause of malignant ureteric obstruction and types of interventions carried out were extracted. In addition, mean serum creatinine level at presentation and one-month post intervention were analysed. The overall patient survival over a 6-month period was evaluated. Data were analysed using SPSS version 23. Result 24 patients managed within the period of the study had complete data for analysis. The age range was 43-73years with a median of 49 years. Majority (79.2%) of patients were female. 54.2% of the patients had open nephrostomy. Retrograde ureteric stent insertion (16.6%) and permanent haemodialysis (29.2%) were the other palliative management options. Open nephrostomy offered the most significant improvement in biochemical outcome at one-month post intervention (P = 0.039). 41.6% of patients were alive at 6 months post intervention. None of the treatment options conferred survival advantage over the others. Conclusion Open nephrostomy is the most common palliative management option for patients with bilateral malignant ureteric obstruction at JUTH and achieves the most significant biochemical improvement. No palliative management option conferred superior survival outcome among the patients.