Impact of Percutaneous Nephrostomy on Clinical Outcome in Advanced Cervical Carcinoma With Obstructive Uropathy at Kenyatta National Hospital From 2016-2019: a Descriptive Retrospective Cohort Study

Abstract

Introduction: Cervical carcinoma is one of the main causes of mortality with a mortality rate of 22.8% in Kenya and most frequent among women between the ages of 15 and 44 years. It can cause obstructive urinary complications, either due to local expansion or pelvic metastases. Percutaneous nephrostomy can be performed to relieve the urinary obstruction. There is limited local and regional studies on the impact the percutaneous nephrostomy has on the quality of life of the patient and the renal function of the patient. This study will use hospital data and records to evaluate survival and performance status among patients with advanced cervical carcinoma after palliative urinary diversion. Objective: To determine the impact of percutaneous nephrostomy on the quality of life of the patient and the renal function of the patient. Methodology: The study design was a descriptive retrospective cohort study, conducted in the gynaecological wards 1B and 1D in the Department of Obstetrics and Gynaecology at Kenyatta National Hospital (KNH) from 2016-2019. Records of the women with cervical carcinoma and obstructive uropathy, and who met the inclusion criteria, were evaluated and data relevant for the study was collected by filling a pre-coded form and entered into an MS excel database. The impact on quality of life was assessed and scored by the FACT-Cx tool, and analysed and presented as frequencies and proportions. The impact on renal functions, by assessing the change in urea/creatinine/Haemoglobin (Hb) levels before and, 72 hours, 1 month and 3 months after the procedure, was analyzed by using a paired sample t-test and presented as mean with standard deviation and with median with interquartile range. Results: Records of 58 women who were managed in KNH between the years 2016 and 2019 for advanced cancer of the cervix and obstructed uropathy and had a PCN inserted, were retrieved and analysed. General sociodemographic and clinical characteristics were analysed further to assess the 15 impact of PCN in their quality of life before and after the procedure, and renal functions before, 72 hours, 1 month and 3 months after the procedure. Insertion of PCN was found to improve the QOL (p=0.041), mainly in the aspects of PWB (p=0.018) and CxCs (p=<0.001) whereas SWB (p=0.666), EWB (p=0.454) and FWB (p=0.200) had no improvement. Insertion of PCN improved the renal functions slightly. There was an improvement of urea levels in 62% of the patients (72 hours p=0.029; 1 month p=0.139; 3 months p=0.099). There was an improvement of creatinine levels in 64% of the patients (72 hours p=<0.001; 1 month p=<0.001; 3 months p=0.003). There was a slight improvement of Hb levels in 48% of the patients but with no statistical significance (72 hours p=0.276; 1 month p=0.555; 3 months p=0.444). Conclusion: The insertion of PCN had minimal added value in management to women with obstructed uropathy in advanced cervical cancer as only two aspects of their QOL improved slightly, while urea and creatinine levels improved slightly before worsening and Hb levels had almost no improvement. Recommendations: Women with advanced cervical cancer and obstructive uropathy would not benefit from the added financial cost of the insertion of a PCN. Other alternative modes of management such as dialysis in addition to chemotherapy and radiotherapy would be more beneficial to the patient.