Volume 24, Issue 106, November - December, 2020

Single position for the management of ureterohydronephrosis in advanced malignancies

Vikas Sharma^1♦, Singh Dinesh¹, Gulati Smita², Agarwal Ankur¹, Gaur Abhay¹, Garg Pulkit¹, Khan Rafey¹

¹Department of Urology, Rajiv Gandhi Super Speciality Hospital, Tahirpur, New Delhi, India
²Department of Anesthesia and Pain Clinic, Rajiv Gandhi Super Speciality Hospital, Tahirpur, New Delhi, India

^♦Corresponding author
Vikas Sharma, Department of Urology, Rajiv Gandhi Super Speciality Hospital, Tahirpur, New Delhi, India

ABSTRACT

Introduction: Management of ureteral obstruction in the advanced abdominal or pelvic malignancy is challenging. Management of such patients requires percutaneous nephrostomy tube (PCN) placement or indwelling ureteral double j (DJ) stent insertion for drainage of the obstruction. Endoscopic DJ stent insertion is commonly done in lithotomy position but PCN placement in the prone position. Change of patient's position is often required in the failure of one method of urine drainage. Management of ureteral obstruction in Flank free oblique supine modified lithotomy position (fosml) position allows DJ stent placement in both retrograde & antegrade manner along with PCN insertion. We report our experience with the FOSML position for the management of ureterohydronephrosis in a single position. Materials and Methods: All patients who underwent urinary drainage for ureteral obstruction secondary to advanced malignant disease in the FOSML position from January 2019 to February 2020 were prospectively included in the study after meeting inclusion criteria. In all the cases, preference was given to DJ stent insertion. PCN placement was performed after failure to stent the patient in both retrograde and antegrade attempts. Results: Out of 36 patients of ureterohydronephrosis, 15 underwent retrograde DJ stent insertion, 3 patients had successful antegrade DJ stent insertion, and the remaining 18 patients underwent PCN insertion after the failure of retrograde and antegrade ureteral stent placement. Conclusion: FOSML position is safe and feasible for managing ureterohydronephrosis secondary to pelvic malignancy. It avoids the surgeon's dependency on more than one position for urine drainage and saves crucial operative time.

Keywords: Single position; ureteral obstruction; management; FOSML

Medical Science, 2020, 24(106), 3961-3966

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