Impact of percutaneous nephrostomy in obstructive uropathy in advanced malignancies: A tertiary care cancer hospital experience

Introduction: To assess whether percutaneous nephrostomy (PCN) placement in malignant ureteric obstruction provided any additional benefit or reduced patient morbidity and mortality, to review renal function recovery post-PCN insertion, length of hospital stays, and survival post-PCN insertion. Methodology: We retrospectively analyzed 100 out of 300 patients who underwent PCN insertion while receiving active cancer treatment at SKMCH from January 2019 to June 2022. Data was collected on demographics, primary disease, stage, renal function recovery, complications, hospital stay, and mortality. Results: Most patients were males over 60 years. Bladder Cancer was the most common malignancy, and most people had locally advanced diseases. Almost half of the patients returned to EAR (Emergency Assessment Room) due to symptoms related to PCN. Most visits were within the first 30 days. PCN displacement was the most frequent complication. Almost one-third of patients require repeat PCN insertion (most within 60 days). Most patients’ renal function recovered to baseline, however a significant proportion (more than 1/3rd) developed Chronic Kidney Disease (CKD). The renal function never recovered in about a quarter of patients. Almost 50% of patients either died or were lost to follow-up. Poor survival in people with recurrent/ metastatic disease. Conclusion: PCN insertion may not improve outcomes in patients with advanced malignancies but can be performed as a palliative procedure to improve the quality of life in a selected set of patients. Unnecessary intervention may add discomfort and a socioeconomic burden on patients and their families so it should be avoided by good initial clinical assessment.