Longitudinal Outcomes of Malignant Ureteral Obstruction Secondary to Ovarian Cancer: Predictors of Resolution and the Role of Surgical Management

Kathryn N Faidley; Hannah E Botkin; Bradley T Loeffler; Sarah L Mott; Samuel C Hansen; Emily K Hill; Bradley A Erickson

doi:10.1016/j.urology.2024.02.001

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Longitudinal Outcomes of Malignant Ureteral Obstruction Secondary to Ovarian Cancer: Predictors of Resolution and the Role of Surgical Management

Journal article

Peer reviewed

Longitudinal Outcomes of Malignant Ureteral Obstruction Secondary to Ovarian Cancer: Predictors of Resolution and the Role of Surgical Management

Kathryn N Faidley, Hannah E Botkin, Bradley T Loeffler, Sarah L Mott, Samuel C Hansen, Emily K Hill and Bradley A Erickson

Urology (Ridgewood, N.J.), Vol.186, pp.101-106

04/2024

DOI: 10.1016/j.urology.2024.02.001

PMCID: PMC11816973

PMID: 38350551

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Abstract

To review the management of ovarian cancer (OCa) associated hydronephrosis (HN). Specifically, we aim to identify optimal management of HN in the acute setting, predictors of HN resolution, and the role of surgery (tumor debulking/(+/-)ureterolysis/hysterectomy). The study cohort included OCa patients managed at our institution from 2004-19 that developed OCa-associated HN. Initial HN management was recorded as none, retrograde ureteral stent (RUS) or percutaneous nephrostomy tube (PCN). Primary outcomes included 1) HN management failure 2) HN management complications and 3) HN resolution. Patient, cancer, and treatment predictors of outcomes were assessed using logistic regression and Fine-Gray competing risk models. Of 2580 OCa patients, 190 (7.4%) developed HN. HN was treated in 121; 90 (74.4%) with RUS, 31 (25.6%) with PCN. Complication rates were similar between PCN and RUS (83% v. 85.1%; p = 0.79; all Clavian Grade I/II). Initial HN treatment failure occurred in 28 patients, predicted by renal atrophy (HR 3.27, p<0.01). HN resolution occurred in only 52 (27%) patients and was predicted by lower FIGO stage (FIGO III/IV HR 0.42 p<0.01) and surgical tumor debulking/ureterolysis (HR 2.83 p = 0.02). Resolution of HN associated with malignant obstruction from OCa is rare and is most closely associated with tumor debulking and FIGO stage. Initial endoscopic treatment modality was not significantly associated with complications or resolution, though RUS failures were slightly more commonly. Ureteral reconstruction at time of debulking/ureterolysis is potentially underutilized.

Ovarian Cancer

Percutaneous Nephrostomy Tube

Ureteral Stent

Hydronephrosis

Tumor-Debulking

Details

Title: Subtitle: Longitudinal Outcomes of Malignant Ureteral Obstruction Secondary to Ovarian Cancer: Predictors of Resolution and the Role of Surgical Management
Creators: Kathryn N Faidley - University of Iowa
Hannah E Botkin - University of Iowa
Bradley T Loeffler - University of Iowa
Sarah L Mott - University of Iowa
Samuel C Hansen - University of Iowa
Emily K Hill - University of Iowa
Bradley A Erickson - University of Iowa
Resource Type: Journal article
Publication Details: Urology (Ridgewood, N.J.), Vol.186, pp.101-106
DOI: 10.1016/j.urology.2024.02.001
PMID: 38350551
PMCID: PMC11816973
NLM abbreviation: Urology
ISSN: 0090-4295
eISSN: 1527-9995
Language: English
Electronic publication date: 02/11/2024
Date published: 04/2024
Academic Unit: Obstetrics and Gynecology; Urology
Record Identifier: 9984559877302771

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