Malignant Upper Urinary Tract Obstruction: Poor Survival and Need for Standardized Reporting

What is it about?

The article discusses the current state of clinical evidence for treating de novo malignant upper urinary tract obstruction. The review protocol was published on PROSPERO and was based on a search of OVID MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials-CENTRAL up to June 2022. The studies included in the review were prospective and retrospective and investigated heterogeneous malignancies. The most studied interventions were percutaneous nephrostomy and ureteric stenting. The reported median survival after intervention was around 11.7 months, and there was a lack of standardized reporting of outcomes. The article concludes that the current evidence base has significant limitations due to studies of low methodological quality and the lack of a standardized framework for reporting outcomes. The authors suggest a pragmatic framework for future studies to ensure a uniform methodology is utilized moving forward.

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Why is it important?

This research is important because it systematically reviews the current clinical evidence for the treatment of de novo malignant upper urinary tract obstruction, with a focus on standards of reporting, patient outcomes, and future research needs. Malignant upper urinary tract obstruction (MUUTO) is a urological condition that affects patients globally and has significant unmet needs, and the best treatment method is unknown. The study highlights the limitations of the current evidence base due to the studies' low methodological quality and the lack of a standardised framework for reporting outcomes. Key Takeaways: 1. The review protocol was published via PROSPERO (CRD42022341588) and included studies from OVID MEDLINE (R), EMBASE, and Cochrane Central Register of Controlled Trials-CENTRAL. 2. Most studies in the published literature are retrospective and investigate heterogenous malignancies. Percutaneous nephrostomy and ureteric stenting are the most studied interventions. 3. Few studies describe the outcomes from no intervention or investigate patient perspectives. Overall reported median survival after intervention was around 11.7 months. 4. A lack of standardised reporting of outcomes was evident, which hinders the comparison of studies and the identification of the most effective treatment. 5. The study highlights the need for a pragmatic framework for future studies to ensure a uniform methodology is utilised moving forward.