Impact of percutaneous nephrostomy in South African women with advanced cervical cancer and obstructive uropathy

Objectives: South Africa women with cervical carcinoma present at younger ages and the majority with advanced-stage disease. Certain patients may have a favourable outcome after placement of a percutaneous nephrostomy (PCN) for obstructive uropathy in cervical cancer. Methods: A retrospective audit was conducted at the Gynaecological Oncology Unit, University of Pretoria. All patients with primary untreated cervical cancer with renal impairment secondary to obstructive uropathy were included. Urea, creatinine and potassium were recorded for patients receiving PCN before insertion and after treatment. Results: In total, 54 patients were included. The mean age was 49.5 years. The number of patients receiving PCN was 28 (51.9%) and 26 (48.1%) women did not. Altogether, 25% of patients had improvement in renal function after insertion of PCN and in 10.3% renal function worsened. Some 50% of these patients received palliative radiotherapy, 7% started therapeutic chemo-radiation and 7% of patients completed treatment. Response to treatment was unknown for 21% of patients, 7% showed partial response and 10.7% died of their disease. In the control group, 15.4% of patients had severe renal failure; 7.7% of patients never started treatment and 7.7% received palliative radiotherapy; 11.5% died of their disease. Some 26.9% of patients without PCN fell in the renal failure group, of whom 19.2% received palliative radiotherapy. Conclusion: PCN in patients with cervical cancer and obstructive uropathy, even if HIV positive, is safe with minimal complications. An improvement in renal function was shown after insertion. PCN improved the number of patients qualifying for initiation and completion of treatment.