Analysis of treatment strategies for patients with obstructive renal failure caused by advanced cervical carcinoma after the failure of retrograde ureteral stent placement

Objective: To analyze treatment strategies for patients with advanced cervical carcinoma with obstructive renal failure after the failure of retrograde ureteral stent placement. Methods: We retrospectively analyzed 68 cases of advanced cervical cancer secondary with ureteral obstruction and had difficulty in indwelling retrograde ureteral stent in recent 7 years (from January, 2008 to June, 2013); after the treatments of hemodialysis, Percutaneous Nephrostomy (PCN) and laparoscopic bilateral cutaneous ureterostomy respectively, we analyzed the 24 h urine volume, renal function, electrolyte, QOL, further therapy for cervical cancer and 2-year survival rate of the patients. Result: One week after the treatments, by comparing 24 h urine volume and serum creatinine values, we found urinary diversion group (2124.8 ± 440.7 ml, 84.0 ± 16.5 ummol/L) was better than PCN group (1062.6 ± 231.1 ml, 197.8 ± 7.8 umol/L) and hemodialysis group (47.0 ± 26.0 ml, 225.4±23.4 umol/L) and the difference was statistically significant (P < 0.05). In the aspect of serum potassium, there was no significant difference between three groups (P > 0.05). The radical radiotherapy probability rate and survival period (18.3 ± 6.1 months) of urinary diversion group were better than that of the other two groups. The difference was statistically significant (P < 0.05). In the aspect of 2-year survival rate, urinary diversion group (48.0%, 12/25) was better than hemodialysis group (0%, 0/20), however, there was no statistical difference (P < 0.05) by comparing with the PCN group (21.7%, 5/23) (P > 0.05). In the aspect of quality of life after operation, the scores of urinary diversion group were distinctly better than the others. Conclusion: For the patients with ureteric obstruction caused by advanced cervical cancer and failed in ureteral stent placement, urinary diversion surgery should be considered with priority for those who could undergo general anesthesia and laparoscopic operation to effectively and thoroughly improve the renal function of patients with long-term stability; it could provide conditions for patients receiving combined treatment for advanced cervical cancer and prolong their survival period and quality of life. If the patient could not undergo general anesthesia and laparoscopic operation, unilateral PCN and hemodialysis could be used as a temporary treatment.