Obstructive uropathy in gynecologic malignancy. Detrimental effect of intraureteral stent placement and value of percutaneous nephrostomy.

Records of all patients with obstructive uropathy and gynecologic malignancy were reviewed to determine treatment, including indications for dialysis, and outcomes. Over 5 years (July, 1989-June, 1994), 41 patients were identified, 34 of whom (83%) had renal failure or insufficiency with a serum creatinine concentration > or = 1.5 mg/dl. All of those with renal failure had hydronephrosis: bilateral in 28 of 34 patients (82%), and unilateral in the rest (18%). There was no consistent approach to management, which appeared unrelated to staging of cancer, and included unilateral nephrostomy alone (n = 6), bilateral nephrostomy (n = 11), intraureteral stent catheter placement alone (n = 5), a combination of nephrostomy and intraureteral stent catheter placement (n = 3), urinary diversion into an ileal conduit (n = 2), or no treatment (n = 7). Of seven patients who had stent catheter placement, urosepsis developed in six (86%), leading to death in three of seven (43%). Bilateral nephrostomy placement was clearly valuable in reversing renal failure (p = 0.002), and superior to unilateral nephrostomy (p = 0.125), intraureteral stent catheter placement alone (p = 0.75), or a combination of nephrostomy and intraureteral stent catheter placement (p = 1.0). Only 2 of 34 patients with renal failure (6%) were dialyzed. This experience indicates that: 1) intraureteral stent catheter placement predisposes to urosepsis and should be avoided; 2) bilateral nephrostomy placement allows significant improvement in renal function, and is superior to either unilateral nephrostomy placement or combination nephrostomy-stent catheter placement; and 3) dialysis is rarely applied to this population.