CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2022; 06(01): 033-036
DOI: 10.1055/s-0042-1744507
Original Article

Establishment of a Percutaneous Nephrostomy Service to Treat Obstructive Uropathy Secondary to Cervical Cancer in Tanzania

Ivan Rukundo
1   Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
,
1   Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
,
Azza Naif
1   Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
,
2   University of Illinois College of Medicine, Chicago, Illinois, United States
,
Fabian Laage-Gaupp
3   Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, United States
,
Murray Asch
4   Diagnostic and Interventional Radiology, Lakeridge Health Corporation, Oshawa, Ontario, Canada
,
Vijay Ramalingam
5   Division of Interventional Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
› Author Affiliations

Abstract

Background Cervical cancer is the fourth most common cancer among women globally. Age-standardized cervical cancer mortality is higher in East Africa than anywhere else in the world. Prior to October 2018, patients presenting with obstructive uropathy secondary to late-stage cervical cancer in Tanzania who were no longer eligible for palliative chemoradiation therapy were discharged home without intervention. The purpose of this study was to evaluate whether the establishment of a percutaneous nephrostomy service in a quaternary hospital in Dar es Salaam, Tanzania, a resource-limited country, benefits patients who have late-stage cancer induced obstructive uropathy.

Materials and Methods A retrospective study was performed on patients who presented with obstructive uropathy secondary to late-stage cervical cancer and have undergone percutaneous nephrostomy at Muhimbili National Hospital and Ocean Road Cancer Institute from October 2018 to May 2021. Twenty-one interventional radiology (IR) teaching teams consisting of IR attendings, IR technologists, and nurses travelled to Tanzania from North America on monthly 2-week trips during that period. A review of preprocedural, procedural, and follow-up data was performed using Research Electronic Data Capture. Statistical analysis and comparison were performed on patients' creatinine levels preprocedure, 7 days and 30 days postprocedure.

Results Sixty-two patients qualified to be included in this study. In addition to the initial 62 nephrostomy placements, 14 follow-up procedures were performed either under visiting faculty supervision or independently by the Tanzanian IR fellows. Technical success rate was 98.7%. Complications (SIR Class A and B) occurred in eight cases. The average preprocedure creatinine (1051.48 ± 704.08µmol/L) decreased by 59% 7 days postprocedure and by 77% 30 days postintervention. Postprocedural clinical information was obtained for 28 (45.2%) patients and 18 were able to restart chemotherapy following nephrostomy.

Conclusion Prior to 2018, percutaneous nephrostomy placement was not available in Tanzania. This study presented the initial safety, technical feasibility, and clinical benefit of establishing a percutaneous nephrostomy service in such a resource-limited setting.



Publication History

Article published online:
20 April 2022

© 2022. The Pan Arab Interventional Radiology Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Arbyn M, Weiderpass E, Bruni L. et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health 2020; 8 (02) e191-e203
  • 2 Ntekim A. Cervical Cancer in Sub Sahara Africa. Topics on Cervical Cancer with an Advocacy for Prevention. 2012 DOI: 10.5772/27200
  • 3 Runge AS, Bernstein ME, Lucas AN, Tewari KS. Cervical cancer in Tanzania: a systematic review of current challenges in six domains. Gynecol Oncol Rep 2019; 29: 40-47
  • 4 Mlange R, Matovelo D, Rambau P, Kidenya B. Patient and disease characteristics associated with late tumour stage at presentation of cervical cancer in northwestern Tanzania. BMC Womens Health 2016; 16: 5
  • 5 Hsu L, Li H, Pucheril D. et al. Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction. World J Nephrol 2016; 5 (02) 172-181
  • 6 van Aardt MC, van Aardt J, Mouton A. Impact of percutaneous nephrostomy in South African women with advanced cervical cancer and obstructive uropathy. Southern African Journal of Gynaecological Oncology 2017; 9 (01) 6-10
  • 7 Santosa KB, Prawira MM, Pramana IBP. et al. Predictor of successful DJ stent insertion in advanced cervical cancer. Open Access Maced J Med Sci 2020; 8 (B): 882-886
  • 8 Mishra K, Desai A, Patel S, Mankad M, Dave K. Role of percutaneous nephrostomy in advanced cervical carcinoma with obstructive uropathy: a case series. Indian J Palliat Care 2009; 15 (01) 37-40
  • 9 Khalilzadeh O, Baerlocher MO, Shyn PB. et al. Proposal of a new adverse event classification by the Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol 2017; 28 (10) 1432-1437.e3
  • 10 Laage Gaupp FM, Solomon N, Rukundo I. et al. Tanzania IR initiative: training the first generation of interventional radiologists. J Vasc Interv Radiol 2019; 30 (12) 2036-2040
  • 11 Turo R, Horsu S, Broome J. et al. Complications of percutaneous nephrostomy in a district general hospital. Turk J Urol 2018; 44 (06) 478-483
  • 12 Li AC, Regalado SP. Emergent percutaneous nephrostomy for the diagnosis and management of pyonephrosis. Semin Intervent Radiol 2012; 29 (03) 218-225
  • 13 New FJ, Deverill SJ, Somani BK. Outcomes related to percutaneous nephrostomies (PCN) in malignancy-associated ureteric obstruction: a systematic review of the literature. J Clin Med 2021; 10 (11) 2354