Malignant upper urinary tract obstruction: A prospective evaluation of patients presenting as an emergency to urology and their long-term real-life outcomes

Abstract

Objective: The objective of this study was to evaluate the management and survival outcomes of patients referred to urology as an emergency with malignant upper urinary tract obstruction (MUUTO). Patients and Methods: Between 2019 and 2020, the outcomes of all emergency referrals with MUUTO to the Urology team at a single institution were prospectively analysed. Results: In total, 119 patients, median age 77 years, were referred to the urology team with MUUTO. Of these, 59% (70/119) had bilateral and 41% (49/119) unilateral obstruction. The three commonest primary underlying malignancies were bladder (41% (49/119)), prostate (19% (23/119)), and colorectal (8% (10/119)) cancer. The commonest indication for referral was acute kidney injury (86% (103/119)), the remainder had sepsis (13% (15/119)), and pain (1% (1/119)). Median in-patient stay for the admission was 7 days. Median estimated glomerular filtration rate (eGFR/1.73 m2) measured on discharge improved irrespective of whether intervention for MUUTO was received. Overall survival of the cohort was 13% (16/119). Conclusions: Patients referred with MUUTO as an emergency have a poor prognosis. Renal function does not significantly deteriorate in the short term in this patient group with no intervention, and overall survival is not significantly improved after intervention unless further treatment is received. Multidisciplinary team discussion, including patients and oncologists, should be best practice before intervention in this challenging situation. Level of evidence: 2b