Quality of life, pain and anxiety in patients with nephrostomy tubes.

OBJECTIVE: to evaluate the impact on the quality of life as well as anxiety and pain in patients with nephrostomy tubes. METHOD: this is a longitudinal descriptive study performed on a sample of n=150 patients. To evaluate the quality of life, the EuroQol-5D questionnaire was used; anxiety was quantified by the Beck Anxiety Inventory; to study pain, a visual analogue scale was employed. RESULTS: statistically significant differences were found in the quality of life, with its worsening (r = 0.51; p <0.01) when evaluated at the first tube replacement. Patients presented mild to moderate anxiety before the procedure, which was reduced at the first tube replacement, although this difference was not significant (r = 0.028, p = 0.393). Finally, the degree of pain was also significantly reduced (r = 0.13, p<0.01) after six weeks. As for gender, women presented the worst values ​​in the three variables studied (worse quality of life and greater anxiety and pain). CONCLUSIONS: nephrostomy tubes have a negative impact on the patient's quality of life. During the time they live with these tubes, patients have mild to moderate pain and anxiety.

A qualitative study exploring male cancer patients' experiences with percutaneous nephrostomy.

OBJECTIVE: Obstructive uropathy due to advanced cancer can be efficiently treated with a percutaneous nephrostomy. The treatment is associated with complications and frequent readmissions. How the patients' quality of life is affected by a nephrostomy remains uncertain. The aim of this study was to describe how a nephrostomy is perceived by patients and its effects on their everyday lives. MATERIAL AND METHODS: Semi-structured interviews were conducted in the patients' home using a mind map. The inclusion criteria were locally advanced or metastatic urological cancer treated with a nephrostomy for a minimum of 1 month. All interviews were audio recorded, transcribed and analysed using a grounded theory approach. Ten male patients were interviewed, eight with prostate cancer and two with bladder cancer. RESULTS: Treatment with nephrostomy influenced the physical activity level and restricted normal social activities. Readmissions had a negative influence on mood. However, the patients who experienced symptom improvement were thankful for having had the nephrostomy, despite the inconveniences. Communicating about the hazards and benefits helped patients to adjust their expectations of a nephrostomy. CONCLUSIONS: The study describes how nephrostomy is a burdensome intervention accompanied by a plethora of complex physical and psychosocial issues. Having a nephrostomy on a palliative indication has extensive implications for the patients, which should not be neglected or underestimated. Individual assessment of each patient, together with excellent communication regarding the procedure and outcome, is essential. Most patients had frequent contact with the healthcare system and additional support could be offered by a palliative care service.

Impact of palliative urinary diversion by percutaneous nephrostomy drainage and ureteral stenting among patients with advanced cervical cancer and obstructive uropathy: a prospective cohort.

AIM: Obstructive uropathy is a recognized complication in advanced cervical cancer. Urinary diversion is commonly used to bypass the obstruction and improve renal function. The degree of survival benefit that diversion offers is not well established and its impact on quality of life (QoL) is uncertain. This study considered these factors in order to inform treatment decisions. METHODS: This study examined a prospective cohort of patients with advanced cervical cancer and obstructive uropathy in Manila, Philippines. Age, cancer treatment status, comorbidities, serum creatinine level, degree of obstructive uropathy and QoL were recorded at baseline. Patients with creatinine values >150 µmol/L, or who were being considered for radiotherapy or nephrotoxic chemotherapy or manifesting uncontrolled or recurrent uropathy-related urinary tract infection, were offered diversion. Follow-up data collection was at 3, 6, 9 and 12 months from cohort entry. RESULTS: Of the 230 patients invited, 205 patients joined the cohort. Complete data were available for 198, of whom 93 underwent diversion, 56 required diversion but elected not to receive it, and 49 did not require it. Although survival at 12 months among those who underwent diversion was no greater than among those who required but elected not to receive the procedure, diversion was associated with significantly improved chance of survival in the shorter term. There was no significant difference in the QoL between the groups throughout the study. CONCLUSION: With no evidence of an impact on QoL, the decision to offer diversionary surgery might be based solely on a survival benefit, which is modest but potentially important to patients.

Percutaneous nephrostomy in patients with tumors of advanced stage: treatment dilemmas and impact on clinical course and quality of life.

OBJECTIVES: The purpose of this study was to evaluate the outcome, in respect to safety, survival, and quality of life (QoL), after performance of percutaneous nephrostomy in patients with obstructive nephropathy caused by various types of advanced malignancy. PATIENTS AND METHODS: A cohort of 270 patients with established nephropathy because of advanced pelvic or nonpelvic tumors was evaluated. A decision to obtain percutaneous access was made; primary stenting had either failed or was not feasible because of complicated anatomy. Patients were divided in equal groups by type of malignancy (54 patients each). In addition, each malignancy group was further divided in two equal subgroups by tumor burden (27 patients each). Correlations were made with respect to renal function outcome, overall survival after the procedure, and QoL differences both before and after the procedure. RESULTS: No serious complications, such as severe bleeding or sepsis, were experienced because of the procedure. Statistical analysis showed no significant differences in survival among patients with different types of cancer. Only patients with prostate (P < 0.0365) and colorectal (P < 0.0307) cancer with lower tumor burden had significantly longer survival when compared with patients with large tumor burden. Regarding QoL scores, only patients with prostate cancer in the subgroup with low tumor burden demonstrated a positive statistically significant difference (P < 0.001). CONCLUSIONS: Despite the fact that percutaneous nephrostomy has shown good safety characteristics and beneficial impact on renal function, only patients with specific cancers most likely to respond to ongoing palliative therapy or with cancers that progress slowly by nature may statistically benefit from the procedure. This questions the universal application of this procedure for all types and stages of advanced malignancy.

Quality of life after percutaneous nephrolithotomy for caliceal diverticulum and secluded lower-pole renal stones.

BACKGROUND AND PURPOSE: The treatment of caliceal diverticulum and deeply secluded lower-pole stones is challenging, and the indications are controversial. This study assessed the changes in the quality of life (QoL) of patients undergoing percutaneous nephrolithotomy (PCNL) for symptomatic caliceal diverticula and deep lower-pole calculi to determine whether there is a change in the "bother factor" in order to improve treatment strategies for this group of patients. PATIENTS AND METHODS: Twenty-two patients undergoing PCNL were evaluated prospectively using the SF36 QoL questionnaire before and 6 weeks after PCNL. The results before and after PCNL were compared individually and by group and analyzed statistically. A P value

Quantitative measurement of anxiety in patients undergoing surgery for renal calculus disease.

The anxiety experienced by patients undergoing surgical procedures is well documented and may affect the outcome of any operation. This has not been considered in modern urological surgery which is moving away from highly-invasive techniques towards minimal and even non-invasive procedures. Little work has been carried out to examine the patient's reaction to this new technology. This work has two aims: to assess patient anxiety before and after different procedures for renal calculus removal and to identify, where possible, factors that contribute to pre- and post-operative anxiety. The main method of quantifying stress was the measurement of palmar sweat by means of an evaporimeter. Other measurements used were a bi-polar visual analogue scale and the Spielberger State Anxiety Questionnaire. The results of the study demonstrated a highly significant reduction in the palmar sweat production (P less than 0.0001) and score obtained for the analogue scale (P less than 0.05) following open surgery, but no changes before and after treatment in any of the variables in patients undergoing percutaneous nephrolithotomy or lithotripsy. Analysis of the data in relation to the surgery demonstrated a significantly higher preoperative analogue score in patients undergoing open surgery compared with lithotripsy (P less than 0.05). Post-operatively, patients undergoing lithotripsy had a significantly higher palmar sweat response compared with patients undergoing open surgery (P less than 0.01). Pre-operatively, fear of a general anaesthetic was identified as a factor contributing to anxiety and post-operatively, pain was the most commonly identified stressor. The implications of these results to the patient and to both nursing and medical staff in terms of practice are discussed. This must include a careful pre-operative explanation.

[Therapeutic and ethical problems of nephrostomy in tumor-related hydronephrosis]. / Die therapeutischen und ethischen Probleme der Nephrostomie bei tumorbedingten Harnstauungsnieren.

A total of 101 patients with hydronephrosis due to tumor obstruction underwent palliative nephrostomies. The average survival was 8.6 months; after 3 months, 32% of the patients were dead. The survival for patients with T3 tumors was 9.3 and for patients with T4 tumors, 6.0 months. The general postoperative health status did not improve in any of the cases. Retrospectively, 42% of the patients did not feel that the nephrostomy had done any good. In 17% of the cases, progressive development of tumor growth was predictable at the time of nephrostomy.