Urological intervention for salvage of renal function in carcinoma cervix cases –institutional experience

Over 70% patients with cancer cervix present in advanced stages of the disease with coexisting urological complications like obstructed uropathy. Patients with advanced or recurrent disease frequently develop infiltration of neighbouring organs like urinary bladder, ureter, resulting in urinary complications including obstruction, fistula formation. The most common presenting symptoms were flank pain, followed by dysuria,elevated renal parameters, urinary leak, pedal edema, oliguria or anuria.
Aim of Study: To evaluate the clinical outcome of the various urological intervention administered in a patient with carcinoma cervix.
Material and Methods: In this study, 33 patients with advanced cancer cervix (stage IIB and above) admitted in Government Royapettah hospital period of AUG 2016 – JULY 2018. Patient with ca cervix previously treated or untreated, who had obstructed uropathy were evaluated to know the type of urological complications, management and their clinical outcomes were retrospectively analyzed. Proper history and clinical examination, h/o regarding duration of disease, urinary symptoms ,treatment in the form of surgery, chemotherapy or radiotherapy was elicited in detail.Patients were then investigated with urine analysis, renal function tests, complete blood count, USG KUB,IVU/CECT KUB/MR UROGRAM and Cystoscopy findings were evaluated .
Results: In our study, urological complications were common in the 45 – 50 years of age group. Most common presentation was flank pain ,followed by dysuria,and elevated renal parameters.
Renal function test elevated in 15 patients,mean creatinine value 2.4 mg/dl maximum of 4.7 mg/dl, normal in 18 patients.A total of 18 patient had percutaneous nephrostomy and showed clinical improvement. Surgical procedures were Ureteric reimplantation done in two cases, Uretero colonic anastomosis done in two cases,Ureteric reimplantation with psoas stich done in one case ,Ileal conduit done in one case,Vesicovaginal fistula repair done in one case.
On analyzing the clinical outcome of patients following urological intervention , about 84.8% of patients showed some improvement but 15.2% no signicant improvement due to progression of disease and loss of follow up.
Conclusion: Advanced cancer of the cervix leads on to obstructive uropathy, presenting as uraemia. Various urinary diversion procedures are useful in improving renal function, followed by definitive treatment options. At times they serve as life saving procedures.