The role of percutaneous nephrostomy in gynecologic oncology

Percutaneous nephrostomy can provide rapid relief of renal failure due to ureteral obstruction by contiguous spread of cervical malignancy. A series of 26 percutaneous nephrostomies placed in 14 patients with cervical cancer, using only local anesthesia and ultrasound or fluoroscopic guidance is presented. Twelve patients experienced no complications, one developed pyelonephritis which cleared rapidly with antibiotics, and one suffered a hematoma managed by surgical nephrostomy. Three of six previously untreated patients and one of eight patients with recurrent disease survived over a year. A single exenterated patient was stented when anuria developed after surgery to correct a conduit leak. This patient survives at 1.5 years with no evidence of recurrence. Indications for percutaneous nephrostomy, anticipated benefits, and the decision-making process involved in determining who to stent is reviewed.