Abstract:

Objective  To explore the theraputic strategies for patients with bilateral ureteral obstruction caused by advanced cervical cancer who has failed to place the ureteral stent. Methods  Clinical data of 32 patients with bilateral ureteral obstruction caused by advanced cervical cancer who had failed to place the ureteral stent was retrospectively analyzed. Patients were divided into three groups that underwent hemodialysis (hemodialysis group), percutaneous nephrostomy (PCN group), and laparoscopic cutaneous ureterostomy (urinary diversion group), respectively. The 24 h urine volume, renal function, electrolyte, quality of life (QOL), further treatment of cervical cancer, and 2 year survival rate of three groups before and after treatment were compared. Results  The 24 h urine volume of urinary diversion group one week after treatment was the most, followed by PCN group, then the hemodialysis group. The differences were statistically significant (P<0.01). The serum creatinine level of urinary diversion group was remarkably lower than that of PCN group and hemodialysis group and the differences were statistically significant (P<0.01). The differences of blood potassium level among three groups were not statistically significant (P>0.05). The rate of undergoing radical radiotherapy and survival time of urinary diversion group were remarkably better than those of other groups and the differences were statistically significant (P<0.05). The two-year survival rate of urinary diversion group was better than that of hemodialysis group (P<0.05), while the difference of two-year survival rate between urinary diversion group and PCN group was not statistically significant (P>0.05). The postoperative QOL score of urinary diversion group was remarkably better than that of other two groups (P<0.05). Conclusion  For patients with bilateral ureteral obstruction caused by advanced cervical cancer who has failed to place the ureteral stent, theraputic strategies should be chosen according to different conditions in order to effectively improve the renal function of patients, create conditions for further treatment of advanced cervical cancer, prolong the survival time of patients, and improve the quality of life.

Key words: advanced cervical cancer, ureteric obstruction, renal dysfunction, hemodialysis, percutaneous nephrostomy, laparoscopic cutaneous ureterostomy, prognosis