Longitudinal Outcomes of Malignant Ureteral Obstruction Secondary to Ovarian Cancer: Predictors of Resolution and the Role of Surgical Management

Purpose To review the management of ovarian cancer (OCa) associated hydronephrosis (HN). Specifically, we aim to identify optimal management of HN in the acute setting, predictors of HN resolution, and the role of surgery (tumor debulking/(+/-)ureterolysis/hysterectomy). Materials/Methods The study cohort included OCa patients managed at our institution from 2004-19 that developed OCa-associated HN. Initial HN management was recorded as none, retrograde ureteral stent (RUS) or percutaneous nephrostomy tube (PCN). Primary outcomes included 1) HN management failure 2) HN management complications and 3) HN resolution. Patient, cancer, and treatment predictors of outcomes were assessed using logistic regression and Fine-Gray competing risk models. Results Of 2580 OCa patients, 190 (7.4%) developed HN. HN was treated in 121; 90 (74.4%) with RUS, 31 (25.6%) with PCN. Complication rates were similar between PCN and RUS (83% v. 85.1%; p = 0.79; all Clavian Grade I/II). Initial HN treatment failure occurred in 28 patients, predicted by renal atrophy (HR 3.27, p<0.01). HN resolution occurred in only 52 (27%) patients and was predicted by lower FIGO stage (FIGO III/IV HR 0.42 p<0.01) and surgical tumor debulking/ureterolysis (HR 2.83 p = 0.02). Conclusions Resolution of HN associated with malignant obstruction from OCa is rare and is most closely associated with tumor debulking and FIGO stage. Initial endoscopic treatment modality was not significantly associated with complications or resolution, though RUS failures were slightly more commonly. Ureteral reconstruction at time of debulking/ureterolysis is potentially underutilized.