Management, Outcomes and Survival of Patients With Obstructive Uropathy Due to Cervical Cancer Admitted at Kenyatta National Hospital (2014 – 2019)

Abstract

Background: Uterine cervical cancer is associated with long-term infection of the Human Papilloma Virus in 99% of cases. It is the second most common cancer in women in Kenya after breast cancer. The advanced stage of cervical cancer is a common presentation and is associated with complications like obstructive uropathy. Percutaneous nephrostomy and hemodialysis are mostly done to relieve the obstruction and uremia. Controversy still exists on the benefits of interventions to manage obstructive uropathy compared to no intervention and their impact on overall survival duration. Objective: To determine management, outcomes, and survival of patients with obstructive uropathy due to cervical cancer admitted at Kenyatta National Hospital (2014 – 2019) Study Design: Descriptive Retrospective Cohort Study. Study Population: These were 127 patients with obstructive uropathy due to cervical cancer who were managed at Kenyatta National Hospital between 2014 to 2019. Methodology: A retrospective analysis of 127 patients with a diagnosis of obstructive uropathy due to cervical cancer were included. The proportion of patients who underwent nephrostomy, hemodialysis, or no intervention was determined. The outcome of treatment was evaluated in terms of whether they went on to undergo chemoradiation, chemotherapy alone, radiotherapy alone, or no treatment thereafter. The overall and specific interventions’ two-year survival rate was determined. Results: The two-year overall survival rate was 50.4%. The estimated proportions of post-diagnosis procedures done were (95% confidence interval) double j stent 1 ([CI] 0.0%–10.1%), hemodialysis19 (14.8% CI 6.3%–24.1%), PCN 55(43.0% (CI 3 4.4%–52.2%), PCN + hemodialysis 19 (15.6% (CI 7.0%–24.9%) and no intervention 33 (25.8%% (CI 17.2%–35.1%). Specific overall two-year survival rates as per intervention done was (95% CI) PCN 35(54.7% (43.8-67.5), HEM11(17.2%(6.3-30), PNH7(10.9%(0.0-23.7) no intervention 10(15.6%(4.7 -28.4%). Conclusion: Obstructive uropathy negatively impacts the prognosis of advanced cervical cancer. Percutaneous nephrostomy was the best choice to relieve the obstruction and it impacted the two-year survival rate and whether the patient underwent palliative or definitive treatment