Title : Malignant upper urinary tract obstruction in cancer patients: A systematic review
Abstract:
Objective: To systematically summarize the current clinical evidence for de novo malignant upper urinary tract obstruction treatment with a focus on standards of reporting, patient outcomes and future research needs.
Methods: This review protocol was published via PROSPERO (CRD42022341588). OVID MEDLINE (R), EMBASE, Cochrane Central Register of Controlled Trials – CENTRAL were searched up to June 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Prospective and retrospective studies were included.
Results: Of 941 articles identified, 82 with 8,796 patients were eligible for inclusion. Most studies in the published literature are retrospective and investigate heterogenous malignancies. Percutaneous nephrostomy and ureteric stenting are the most studied interventions. Few studies describe the outcomes from no intervention or investigate patient perspectives. Overall reported median survival after intervention was around 11.7 months. A lack of standardised reporting of outcomes was evident.
Conclusions: Malignant upper urinary tract obstruction is an important clinical condition affecting patients globally. Overall survival after intervention appears poor however the current evidence base has significant limitations due to studies of low methodological quality and the lack of a standardised framework for reporting outcomes. We have provided a pragmatic framework for future studies based on the review to ensure a uniform methodology is utilised moving forward.
Audience Take Away Notes:
- Education on an important clinical condition affecting advanced cancer patients globally. Currently there are no guidelines on treatment for these patients
- Discussion of the reported outcomes in the literature as well as the quality of that work to date
- This review encourages centres to carry out research into this understudied condition. It supports this work to be of high quality and consequently of more use to the wider community. This will begin to develop a body of research that can inform treatment decisions for these patients nearing the ends of their lives
