Shivashankarappa Mudegoudar1, Gururaj R. Padasalagi2, Ravishankar Ths3, Rajesh Ranjan4, Saurabh Joshi5
INTRODUCTION
The incidence of patients presenting with advanced pelvic malignancy with obstructive uropathy is high in our country. Relentless progress of the malignancy will cause deterioration of renal function, aggravation of pain, infection, deterioration of Quality of Life (QOL), uremia and death. Decreased renal function is considered as a contraindication for palliative chemo and radiotherapy. However urinary diversion in these patients will lead to improvement in renal function and may help in administration of palliative therapy and thus, improve the quality of life of these patients.
MATERIALS AND METHODS
The present study includes the obstructive uropathy patients secondary to pelvic malignancy referred to our institution for urinary diversion between Jan 2010 to Dec 2014. Total 40 patients were included, of which, 25 patients underwent PCN, 9 patients retrograde DJ stenting, 4 patients refused the treatment, 2 patients were not fit for any intervention due to coagulopathy & comorbid conditions. Of 34 treated patients, 30 were female patients and 4 were male patients. All the patients were explained about the procedure and proper consent taken. Laboratory investigations like CBC, coagulation profile, LFT, routine urine analysis, urine C&S and serum electrolytes were carried out. Haemodialysis was done for 10 patients whose serum creatinine was >6mg% & potassium >6meq. USG guided PCN insertion was done in 8 patients, and in those who failed in this procedure, fluoroscopic C-ARM guided PCN insertion done in 17 patients. Post operatively RFT and serum electrolytes were assessed on 3, 7, 15, & 30th day. PCN catheter was changed once in 3 months.
RESULTS
8 patients succeeded in USG guided PCN insertion and 17 patients who failed USG PCN insertion, was done under C–Arm guidance. 3 patients received blood transfusion. No deaths were seen during or post procedure in the hospital. Renal functions improved and normalised in most of the patients. 6pts died within 3 months of starting palliative chemo-radiotherapy. 5pts died within 3-6 months, 3pts died at 6 months and 3pts died after 9months of therapy. 9pts died after 1 year and 4 survived up to 2 years. 4pts lost to follow up. DJ stenting (9pts) was done under local anaesthesia whereas fluoroscopic PCN was done under GA. Complications seen were reinsertion of PCN tube due to slipped out tubes in 4 patients and 5pts had pericatheter leak, which subsided after sometime. Pain & fever has significantly come down. Renal function improved & came down to normal values in 13pts within 2weeks of PCN, after 3 weeks in 7pts and after 4 weeks in 2pts. In 2pts RF increased after 3 months of chemo–radio therapy.
CONCLUSION
Morbidity related to malignant disease and symptoms were significantly improved after urinary diversion and allowed patients to be submitted for palliative treatment.
