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

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.

Carcinoma cervix; Percutaneous nephrostomy; Urinary obstruction; Quality of life; Kidney function; FACT-Cx

[1] Catalan Institute of Oncology & International Agency for Research on Cancer. Key data on HPV and HPV-related cancers. Cancer Fact sheets. 2017; 1: 1–9.

[2] International Agency for Research on Cancer. Kenya: Globocan 2020. World Health Organization. 2020. Available at: https://gco.iarc.fr/today/data/factsheets/populations/404-kenya-fact-sheets.pdf (Accessed: 2020).

[3] International Agency for Research on Cancer. Cervix uteri: Globocan 2020. World Health Organization. 2020. Available at: https://gco.iarc.fr/today/data/factsheets/cancers/23-Cervix-uteri-fact-sheet.pdf (Accessed: 2020).

[4] Perri T, Meller E, Ben-Baruch G, Inbar Y, Apter S, Heyman L, et al. Palliative urinary diversion in patients with malignant ureteric obstruction due to gynaecological cancer. BMJ Supportive & Palliative Care. 2022; 12: e855–e861.

[5] Hopkins MP, Morley GW. Prognostic factors in advanced stage squamous cell cancer of the cervix. Cancer. 1993; 72: 2389–2393.

[6] Thapa N, Maharjan M, Xiong Y, Jiang D, Nguyen T-P, Petrini MA, et al. Impact of cervical cancer on quality of life of women in Hubei, China. Scientific Reports. 2018; 8: 11993.

[7] Francesca N, Sally D, Bhaskar S. Role of percutaneous nephrostomy in end of life prostate cancer patients: a systematic review of literature. Central European Journal of Urology. 2018; 71: 404–409.

[8] Fernández-Cacho LM, Ayesa-Arriola R. Quality of life, pain and anxiety in patients with nephrostomy tubes. Revista Latino-Americana de Enfermagem. 2019; 27: e3191.

[9] Souza ACPD, Souza AN, Kirsztajn R, Kirsztajn GM. Cervical cancer: renal complications and survival after percutaneous nephrostomy. Revista Da AssociaçãO MéDica Brasileira. 2016; 62: 255–261.

[10] van Aardt MC, van Aardt J, Mouton A. Impact of percutaneous nephrostomy in South African women with advanced cervical cancer and obstructive uropathy. Southern African Journal of Gynaecological Oncology. 2017; 9: 6–10.

[11] Misra S, Coker C, Richenberg J. Percutaneous nephrostomy for ureteric obstruction due to advanced pelvic malignancy: have we got the balance right? International Urology and Nephrology. 2013; 45: 627–632.

[12] Gichangi P, De Vuyst H, Estambale B, Rogo K, Bwayo J, Temmerman M. HIV and cervical cancer in Kenya. International Journal of Gynecology & Obstetrics. 2002; 76: 55–63.

[13] Maranga IO, Hampson L, Oliver AW, Gamal A, Gichangi P, Opiyo A, et al. Analysis of factors contributing to the low survival of cervical cancer patients undergoing radiotherapy in Kenya. PLOS ONE. 2013; 8: e78411.

[14] Lapitan MCM, Buckley BS. Impact of palliative urinary diversion by percutaneous nephrostomy drainage and ureteral stenting among patients with advanced cervical cancer and obstructive uropathy: a prospective cohort. Journal of Obstetrics and Gynaecology Research. 2011; 37: 1061–1070.

[15] Better OS, Arieff AI, Massry SG, Kleeman CR, Maxwell MH. Studies on renal function after relief of complete unilateral ureteral obstruction of three months’ duration in man. The American Journal of Medicine. 1973; 54: 234–240.

[16] Young M, Leslie S. Percutaneous Nephrostomy. StatPearls Publishing: Treasure Island, FL. 2022.

[17] McDevitt JL, Acosta-Torres S, Zhang N, Hu T, Odu A, Wang J, et al. Long-term percutaneous nephrostomy management of malignant urinary obstruction: estimation of optimal exchange frequency and estimation of the financial impact of patient compliance. Journal of Vascular and Interventional Radiology. 2017; 28: 1036–1042.e8.

[18] Folkard SS, Banerjee S, Menzies-Wilson R, Reason J, Psallidas E, Clissold E, et al. Percutaneous nephrostomy in obstructing pelvic malignancy does not facilitate further oncological treatment. International Urology and Nephrology. 2020; 52: 1625–1628.

[19] Jalbani MH, Deenari RA, Dholia KR, Oad AK, Arbani IA. Role of percutaneous nephrostomy (PCN) in malignant ureteral obstruction. Journal of Pakistan Medical Association. 2010; 60: 280–3.

[20] Shoshany O, Erlich T, Golan S, Kleinmann N, Baniel J, Rosenzweig B, et al. Ureteric stent versus percutaneous nephrostomy for acute ureteral obstruction—clinical outcome and quality of life: a bi-center prospective study. BMC Urology. 2019; 19: 79.

[21] Texeira L, Pai BS, Dsouza N. Role of percutaneous nephrostomy in improving quality of life in advanced carcinoma cervix presenting with obstructive uropathy. Journal of South Asian Federation of Obstetrics and Gynaecology. 2019; 11: 107–109.

[22] Qureshi S, Rahman Z, Singh U, Nisha, Srivastav K, Nishchal A. Assessment of quality of life in treated patients of cancer cervix. Journal of Mid-Life Health. 2017; 8: 183.