Prognostic impact of upper urinary tract drainage in obstructive renal failure related to cervical cancer in Guinea: drainage failure as a poor prognostic factor

Abstract

Abstract Introduction The impact of upper urinary tract drainage on survival in patients with cervical cancer complicated by obstructive renal failure remains controversial. The objective of this study was to evaluate the prognostic impact of upper urinary tract drainage on overall survival and the evolution of biological parameters in these patients. Material and methods Prospective single-center study over 18 months (January 2024-May 2025) including 55 patients presenting with cervical cancer with obstructive renal failure at Conakry University Hospital. Drainage modalities (double-J stent, percutaneous nephrostomy) were analyzed. Outcome criteria included overall survival (Kaplan-Meier), evolution of creatininemia and hemoglobin. Logistic regression and Cox model identified independent prognostic factors. Results Mean age was 56.3 years. Stage IIIB predominated (65.5%). Overall drainage success rate was 78.2% (JJ stent insertion 50.9%, nephrostomy 27.3%) with a failure rate of 21.8%. Successful drainage induced a significant decrease in creatininemia (3.7 vs. 0.6 mg/dl, p < 0.001; OR = 19.5) and hemoglobin improvement (3.8 vs. 1.9 g/dl, p < 0.001; OR = 7.2). Median overall survival was 7 months. Drainage failure was associated with poor prognosis (83.3% death before 6 months, median survival 4.5 months, p = 0.0002). Best results combined successful drainage and hemoglobin gain ≥ 3 g/dl (median survival 11.5 months, HR = 0.48 [95% CI: 0.28–0.82]). Conclusion Upper urinary tract drainage significantly improves renal function, hemoglobin, and survival in patients with cervical cancer complicated by obstructive renal failure. Drainage failure constitutes a poor prognostic factor that may support early consideration of exclusive palliative care.