From Death sentance to improved Quality of life; The evolution of management of Malignant Ureteric Obstruction.
BAUS ePoster online library. Calleary J. 06/29/16; 131999; P9-9 Disclosure(s): I have undertaken work for Jansen, Astellas and Pfeizer
John Calleary
John Calleary
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Abstract
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P9-9

Introduction

Death from obstructive renal failure secondary to advanced pelvic malignancy was regarded as a possible desirable outcome. (Meyer et al  Cancer1980; 45: 2698-2701). Treatment was reserved for severe pain or new diagnoses. We track changes in attitudes and techniques which have increased survival but especially quality of life.

Methods

Systematic literature review of databases (eg Pubmed) was performed using keywords such as ureteric/ureteral obstruction, advanced pelvic malignancy and obstructive uropathy. Search dates used were 1900 – 2015. Abstracts of retrieved references were evaluated and relevant papers checked. Diversion method, survival, outcome, complications of diversion and quality of life measures were extracted.

Results

Less than 100 relevant papers were identified. From these two basic eras of clinical management are identifiable. The first involved very selective diversion using ileal conduit or cutaneous ureterostomy and lasted to the mid 1980`s. The second era is associated with increased use of diversion and increased minimally invasive techniques. Use of these has led to reduced complications, reduction in hospitalisation time and has contributed to increased survival.

Conclusion

Brin et al (J Urol May 1975; 113(5): 619-22) in a series of 47 “malignant” diversions showed 23% alive at six months and 2/3 of their time was spent in hospital. Currently minimally invasive techniques used in conjunction with prognostic tabulation can improve both survival and quality of life in up to 66 % of diverted patients (Fiuk et al J Urol. 2015 Apr;193(4):1092-100).  Clearly this represents a vast improvement. The challenge is to continue this sterling work.

 

P9-9

Introduction

Death from obstructive renal failure secondary to advanced pelvic malignancy was regarded as a possible desirable outcome. (Meyer et al  Cancer1980; 45: 2698-2701). Treatment was reserved for severe pain or new diagnoses. We track changes in attitudes and techniques which have increased survival but especially quality of life.

Methods

Systematic literature review of databases (eg Pubmed) was performed using keywords such as ureteric/ureteral obstruction, advanced pelvic malignancy and obstructive uropathy. Search dates used were 1900 – 2015. Abstracts of retrieved references were evaluated and relevant papers checked. Diversion method, survival, outcome, complications of diversion and quality of life measures were extracted.

Results

Less than 100 relevant papers were identified. From these two basic eras of clinical management are identifiable. The first involved very selective diversion using ileal conduit or cutaneous ureterostomy and lasted to the mid 1980`s. The second era is associated with increased use of diversion and increased minimally invasive techniques. Use of these has led to reduced complications, reduction in hospitalisation time and has contributed to increased survival.

Conclusion

Brin et al (J Urol May 1975; 113(5): 619-22) in a series of 47 “malignant” diversions showed 23% alive at six months and 2/3 of their time was spent in hospital. Currently minimally invasive techniques used in conjunction with prognostic tabulation can improve both survival and quality of life in up to 66 % of diverted patients (Fiuk et al J Urol. 2015 Apr;193(4):1092-100).  Clearly this represents a vast improvement. The challenge is to continue this sterling work.

 

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