Malignant upper urinary tract obstruction (MUUTO) is a frequent emergency urological referral, often necessitating kidney drainage to preserve renal function. However, many patients have advanced cancer with limited life expectancy, raising questions about intervention benefits. While percutaneous nephrostomy (PCN) or ureteric stents (US) can relieve obstruction, their impact on survival and quality of life remains unclear, particularly in emergency settings where future treatment options are uncertain. This prospective study evaluated emergency MUUTO referrals, assessing interventions, survival, and outcomes – including patients who declined treatment. Key findings revealed poor short-term survival, especially without subsequent oncological therapy. Notably, patients who opted against intervention showed no significant decline in renal function during admission, challenging assumptions about rapid deterioration without drainage. Median survival was three months with intervention versus one to two months without, though non-intervened patients had fewer readmissions. Only 38% of treated patients received further cancer therapy, underscoring its pivotal role in improving outcomes. Importantly, 10% of intervened patients died within 30 days, highlighting the need for careful patient selection and multidisciplinary discussions before invasive procedures. The study addresses gaps in contemporary data, particularly for non-intervened patients, and emphasises shared decision-making in end-of-life care. Limitations include single-centre design and unmeasured performance status, but the prospective approach minimises selection bias. MUUTO management should prioritise oncology treatment potential over routine decompression. Clinicians can confidently delay intervention to facilitate informed decisions, as renal function may remain stable short-term without drainage. Future research should explore quality-of-life impacts and patient perspectives to refine care pathways.
Malignant upper urinary tract obstruction: emergency presentations and long-term outcomes
Reviewed by Asif H Ansari
Malignant upper urinary tract obstruction: A prospective evaluation of emergency presentations and long-term outcomes.
