Ureteral Reimplantation or Percutaneous Nephrostomy: Which One Is Better in Management of Complete Ureteral Obstruction Due to Advanced Prostate Cancer?

Abstract

Background: The present study aims at evaluating the safety and efficacy of ureteral reimplantation and its influence on quality of life in the complete ureteral obstruction due to prostate cancer. Methods: In a prospective randomized study, 86 patients with complete ureteral obstruction were randomized into 2 groups: group 1 (ureteral reimplantation) and group 2 (nephrostomy). Biochemical values, complications, and survival of patients were recorded. Results: The mean age of patients were 72.20 ± 7.77 and 74.26 ± 7.56 years in group 1 and group 2, respectively (P ₌ 0.21). The mean decrease in Creatinine values were not significant between 2 groups (P = 0.639). The mean survival of patients after intervention were 22.42 ± 0.87 months in group1 and 20.48 ± 0.65 in group 2 (P = 0.0001). No major complications were happened in group 1. Main delayed complications in group 1 were ureteral stricture at the anastomosis point 20% (n = 8), UTI 27.5% (n = 11), and permanent pain at the operation site 15% (n = 6). In group 2, 100% of patients had experienced complications, including: febrile UTI 65.2% (n = 30), perirenal abscess 10.8% (n = 5), dislodgement of nephrostomy tube 30.4% (n = 14), local inflammation and dermatitis of nephrostomy tract 54.3% (n = 25), and hemorrhage during nephrostomy placement 4.3 (n = 2). Likewise, all of them (100%) had social inconvenience, local pain and discomfort in tract and sutures of tube, urine leakage and odor, and need to regular replacement of tube. Conclusions: Reimplantation is a safe and effective option in the management of complete ureteral obstruction due to advanced prostate cancer with significant benefits in overall survival and patient satisfaction.