Gadelkareem Rabea Ahmed, Abdelraouf Ahmed Mahmoud, Ahmed Abdelfattah Ibrahim, El-Taher Ahmed Mohammed, Behnsawy Hosny Mahmoud
Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
Curr Urol. 2023 Dec;17(4):246-250. doi: 10.1097/CU9.0000000000000166. Epub 2022 Nov 16.
There are persistent controversies about the outcomes and benefits of drainage of malignant ureteral obstruction by percutaneous nephrostomy (PCN). This study aimed to assess the predictors of the time-to-nadir (TTN) of serum creatinine (SCr) levels after drainage of bilaterally obstructed kidneys (BOKs) due to bladder cancer (BC) by PCN.
This prospective nonrandomized study included patients with BOKs due to BC treated by PCN between April 2019 and March 2022. The primary outcome measure was TTN.
Of the 55 patients with a median age (range) of 66 years (47-86 years), 32 (58.2%) had a normal nadir SCr and 23 (41.8%) had a high nadir SCr within 21 days after drainage of BOKs due to BC. High nadir SCr was associated with a higher mean age ( = 0.011) and lower body mass index (BMI, = 0.043). However, patients with normal nadir SCr had a significantly shorter TTN ( = 0.023) and an increased mean SCr trajectory ( < 0.001) during TTN. In multivariate analysis, low urine output at presentation ( = 0.021) and high BMI ( = 0.006) were associated with longer TTN. However, the mean parenchymal thickness ( = 0.428) and laterality of drainage ( = 0.466) were not associated with the mean TTN and SCr normalization rates. According to the modified Clavien-Dindo classification, 8 cases of hematuria were managed conservatively (grade 2), and 2 cases of PCN slippage were repositioned using local anesthesia (grade 3).
Despite the safety of PCN for drainage of BOKs due to BC, more than 41% of the patients failed to have a normal nadir SCr. Predrainage low urine output and high BMI were associated with longer TTN. Laterality of drainage had no significant effects on the TTN and SCr trajectory.
经皮肾造瘘术（PCN）治疗恶性输尿管梗阻的疗效和益处一直存在争议。本研究旨在评估因膀胱癌（BC）导致双侧肾脏梗阻（BOKs）的患者经PCN引流后血清肌酐（SCr）水平达到最低点的时间（TTN）的预测因素。
这项前瞻性非随机研究纳入了2019年4月至2022年3月期间因BC接受PCN治疗的BOKs患者。主要结局指标是TTN。
55例患者的中位年龄（范围）为66岁（47 - 86岁），其中32例（58.2%）在因BC导致的BOKs引流后21天内最低点SCr正常，23例（41.8%）最低点SCr较高。最低点SCr较高与平均年龄较大（P = 0.011）和体重指数（BMI）较低（P = 0.043）相关。然而，最低点SCr正常的患者TTN明显较短（P = 0.023），且在TTN期间平均SCr轨迹增加（P < 0.001）。在多变量分析中，就诊时尿量少（P = 0.021）和BMI高（P = 0.006）与TTN较长相关。然而，平均实质厚度（P = 0.428）和引流侧别（P = 0.466）与平均TTN和SCr正常化率无关。根据改良的Clavien - Dindo分类，8例血尿患者保守治疗（2级），2例PCN移位患者在局部麻醉下重新定位（3级）。
尽管PCN用于引流因BC导致的BOKs是安全的，但超过41%的患者最低点SCr未恢复正常。引流前尿量少和BMI高与TTN较长相关。引流侧别对TTN和SCr轨迹无显著影响。
