The challenging management of malignant ureteral obstruction:Analysis of a series of 188 cases

Background:Malignant ureteral obstruction(MUO)is a common condition that complicates the course of advanced malignancies.The aims of this study are to analyze the causes,management,and survival of patients with obstructive nephropathy due to malignant ureteric obstruction and to determine prognostic factors.Furthermore,we studied the complications and outcomes in patients who underwent urinary diversion.Materials and methods:A retrospective study was conducted on patients with computed tomography-confirmed MUO between January 2016 and November 2020.Demographic,clinical,radiological,laboratory,and management data were collected.Survival curves were estimated using the Kaplan-Meier method,and univariate and multivariate Cox proportional hazards models were used to test the association between parameters and survival.Results:A total of 188 patients were included.The mean age was 69.01 years(SD,14.95 years),and the majority(54.8%)were male.The most common mechanism leading to MUO was compression by a pelvic mass(36.9%),and the 3 most frequent tumors causing MUO were prostate(17.6%),bladder(16.5%),and rectal cancer(11.7%).Forty-seven patients(25%)underwent urinary diversion:23(48.9%)underwent double-J stenting and 21(44.7%)underwent percutaneous nephrostomy.The most common reason for urinary diversion was acute kidney injury(53.3%).Recovery of renal function was observed in 55.8%of the patients after urinary diversion.The most frequently identified complications after urinary diversion were urinary tract infection(24.4%),hematuria(17.0%),and urinary sepsis(14.9%).The median survival after hydronephrosis diagnosis was 6.43 months(interquartile range,1.91-14.81 months).In patients who underwent urinary decompression,the median survival after urinary diversion was 8.67 months(interquartile range,2.99-17.28 months).In the multivariate analysis,a lower grade of hydronephrosis and cancer cachexia negatively impacted survival.Conclusions:Cancer patients with MUO have a poor prognosis;therefore,the risk-benefit ratio of urinary diversion should be carefully considered.Cachexia and hydronephrosis grade can be useful in selecting suitable candidates for urinary diversion.

Primary testicular lymphoma:Clinical characteristics and oncological outcomes

Background:Primary testicular lymphoma(PTL)is a rare testicular malignancy,despite being considered the most common testicular tumorin patients olderthan 60 years.Primary testicularlymphoma represents only 1%-9%oftesticular neoplasms.Few studies have been published regarding its clinical features and management.This study aimed to analyze the clinical characteristics and outcomes of PTL.Materials and methods:Orchiectomy specimens of 15 patients with PTL diagnosed during 2000-2020 at our institution were retrospectively studied.We collected information on demographic data,clinical features,management aspects,and outcomes of PTL treatment.Kaplan-Meier survival curves and Cox regression analyses were used to study survival.Results:The median patient age was 69 years(interquartile range,61-72 years).The most prevalent clinical presentation was testicular swelling(80%),and only 13.33%of the patients presented with systemic symptoms.Centralnervous system involvement was detected in 6 patients(40%).Of the 15 patients,5(33.33%)had stage IE and 10(66.67%)had stage IVE lymphoma.Diffuse large B-cell lymphoma was the most common histological subtype.Twelve patients(80%)received chemotherapy.During follow-up,4 patients(26.67%)relapsed.The recurrence ratein the contralateraltesticle was 13.33%.The median cancer-specific survivalwas 21.58 months(95%confidence interval,0-43.95 months).Univariate Cox regression analysis showed that central nervous system involvement and International Prognostic Index score were significantly associated with shorter cancer-specific survival.Conclusions:Primary testicularlymphoma has a high relapse rate and poor prognosis.Management strategies typicallyinclude radical orchiectomy and systemic chemotherapy.Central nervous system involvement and International Prognostic Index scores were associated with lymphoma-specific survival.