EJMED, European Journal of Medical and Health Sciences Vol. 2, No. 2, March 2020 Obstructive Neoplastic Anuria Overview at Ibn Rochd University Hospital–A Retrospective Study Moussaab Rachid, Youness Chakir, Mahdi Graiouid, Mahmoud Alafifi, Mohammed Dakir, Adil Debbagh, and Rachid Aboutaien neoplastic obstacle via a retrospective collection of cases at Abstract— Introduction : Obstructive anuria due to pelvic the urology department of the IBN ROCHD university cancers is the most common obstructive anuria in our context, hospital in Casablanca. its diagnosis is easy, but it causes a lot of morbidity with often heavy and long management. II. METHODS Materials and methods : This is a retrospective study containing 40 cases of confirmed neoplastic anuria treated in This study is a retrospective study carried out in the the urology department at the Ibn Rochd University Hospital urology department of the Ibn Rochd University Hospital in in Casablanca Morocco between January 2016 and October Casablanca from January 2017 to October 2019. The total 2018. number of cases which were included in the study is 40, all Purpose : The aim of our study was to establish the patients were hospitalized due to obstructive anuria caused epidemiological, clinical, therapeutic and natural historyin patients with neoplastic obstructive anuria. by a confirmed neoplastic pathology histologically. A Results : The mean age was 56 years old with a notable literature review was conducted to compare management in female predominance. The male to female ratio was 0.6. Sixty literature with our current practice. percent (60%) of our patients were consulted within24 hours after the onset of anuria, the main symptoms preceding or III. RESULTS accompanying anuria were lower back pain (75%) and hematuria (37.5%). The age of our patients varied between 35 and 77 years Criteria for a positive diagnosis included urinary retention old, with an average of 56 years .This particular disease was with complete absence of diuresis, the anuria was confirmed by found to be more prevalent amongst patient in their forties, probing or ultrasound, dilation of the urinary excretory system fifties. Female predominance was observed with 24 women on ultrasound and acute impairment of renal function. presented with this disease compared to 16 men (ratio of To prevent patient from going into metabolic disorders, 1.5:1). The most common presenting complaint was hemodialysis was performed in 27 patients (67.5%). Internal inability to empty the bladder in 66% of cases (n=27), diversion of urine by mounting a JJ catheter was initially attempted in 40% of the cases. In case of attempt failure, or in followed by lower back pain and hematuria in 40% of cases case of locally advanced pelvic tumors, percutaneous (n=16). Pyuriawas found in 3 cases and pyelonephritis in 4 nephrostomy was performed with a success rate of 100%. cases. The diagnostic delay varied between 12h and 36h Upon follow up for 30 months, mortality rate was 5% (n=2), with an average of 24h.Oligo-anuria onset was progressive 95% of the patients benefited from a specialized follow-up for over an average of 6 days in 37 cases and was brutal in 3 their etiological neoplasm. cases. The symptoms accompanying anuria were: bilateral Conclusion : The management of neoplastic obstructive low back pain in 75% of cases, pelvic pain in 80% of cases anuria must be rapid, the type of urinary diversion is chosen according to the clinical presentation and the technical in different aspects, ranging from simple discomfort to acute platform available. paroxysmal pain, digestive signs such as vomiting and Index Terms—Anuria; Obstructive; Tumor. transit disorders in 30% of cases. 10% of the cases had edema of the lower limbs. We have also observed a case of pulmonary overload, and bilateral fluid effusion syndrome, I. INTRODUCTION and a case of acute pulmonary edema. Fifteen per cent In this study, obstructive anuria of the urinary excretory (15%) of the cases were febrile. A deterioration of the pathway is defined as a complete or near complete cessation general state was marked in 45% of the cases. Pelvic digital of diuresis (less than 200cc or 400cc/24h) which is due to an examination showed a pelvic induration in 16 cases (15 obstruction located at any level of the upper excretory cases of cervical cancer and one case of prostate cancer), pathway. Anuria is caused majorly by an obstruction to the induration of the base of the bladder in two cases, and a excretory system or rarely due to reflex anuria. Obstruction suspicious prostate in digital rectal examination in 11 cases. can be bilateral, or unilateral in case of a single functional or The level of urea varied from 0.88 to 4 g/l with an average anatomical kidney. Whereas, reflex anuria on unilateral of 2.12 g/l, creatinine level varied from 36 to 260 mg/l, with obstacle is rare which represents 2 to 10% of the causes of an average of 121.88 mg/l. The serum concentration varied acute renal failure and its presence requires emergency care. from 126 to 140mEq/l with an average of 135mEq/l. The [1] potassium concentration ranged from 3.6 to 87mEq/l, (with The aim of this study is to evaluate the diagnostic, an average of 5.7mEq/l).The alkaline reserve varied between etiological and therapeutic aspects of anuria secondary to a 9.1 and 31 mEq/l with an average of 20.1 mEq/l. Eighteen patients had anemia with a hemoglobin level varying from 4 PuBlished on March 06, 2020. to 10g/dl. Four patients had a urinary tract infection before DOI: http://dx.doi.org/10.24018/ejmed.2020.2.2.153 1 EJMED, European Journal of Medical and Health Sciences Vol. 2, No. 2, March 2020 anuria. The most common isolated organisms included E. kidney failure because the obstacle is located downstream of coli in 3 cases and one case of Klebsiella. The Ultrasound the kidneys (2). One of the leading causes of obstructive found 37 cases of bilateral uretero-hydronephrosis, one case anuria is pelvic cancer. Few studies are available on the of unilateral uretero-hydronephrosisand two cases of bladder distribution of the organs involved. Colombeau et al. have tumors without dilation. Only two non-contrast computed noted the following etiologies: genital cancers (35%), tomography (CT) exams were performed in immediate prostate cancers (25%), bladder cancers (23%) and digestive emergency. Descending pyelography was performed in all cancers (15%). [3] patients derived by nephrostomy in order to verify the Rakatotiana et al report that 38.09% of the causes of location of the probe and to evaluate the option of internal obstructive anuria were pelvic in a series of 42 cases [4]. In bypass by JJ probe later. Cystoscopy was performed as part a Moroccan series of 30 cases (1995), anuria was due to of an assessment of cervical cancer extension in two cases pelvic cancers in 26.6% of the cases [5]. The neoplastic and one case of prostate cancer. Four cases of bladder tumor obstacle on the excretory pathway leads to a cessation of were objectified. The etiologies of obstructive anuria was diuresis then an increase in the upstream pressure in the dominated by cervical cancer, found in 20 cases, whose age renal tubules and a blockage of glomerular filtration. The was between 36 and 60 years old with stage IIb cervical immediate consequence is the appearance of water, nitrogen, cancer found in one case, IIIa in two cases, IIIb in 16 cases potassium, phosphorus and uric retention, which can be life- and IV in one case. Five patients underwent a colpo- threatening in the short term. Two mechanisms can be hysterectomy with radiotherapy. Radiotherapy with involved in the pathophysiology of neoplastic obstructive chemotherapy was done in 3 cases. Radiotherapy alone was anuria: done in 3 cases. Bladder cancer was diagnosed in 12 cases. 6 • The tumor carries out a direct invasion by contiguity to cases of prostate cancer and 2 cases of rectal ADK were the ureter or the ureteral meatus or it is about an extrinsic identified. The treatment aimed at correcting metabolic compression. disorders, removal of the obstacle and treat the etiology. • A metastasis (by lymph node or retroperitoneal The short-term primary outcome aimed at improvement invasion) of a distant primary tumor. of the renal function in all the patients. Whereas in this A tumoral ureteric invasion is a factor of poor prognosis. study, normalization of renal function was obtained in 60% The diagnosis is made in a patient who has not urinated of patients, while 40% progressed to chronic renal failure of spontaneously for a few hours and whose bladder is empty which 10% progressed to end-stage chronic renal failure. or contains only a few drops of urine on catheterization or One patient died in the department following a massive bladder ultrasound. They may be also associated later signs pulmonary embolism. The 39 patients were referred to the of an acute kidney failure, such as nausea or vomiting various departments for etiological management of their associated with headache, diarrhea and visual disturbances, neoplasms. 75% of the cases regularly followed their or obstructive signs such as back pain [6][1][3].The clinical etiological treatment, 10% of which died for reasons other examination seeks symptoms related to the cause of the than renal failure. 25% of the cases are lost during our obstruction of the excretory pathway such as hematuria, follow-up. urinary disorders related to an adenocarcinoma of the prostate or a bladder tumor, metrorrhagia or leucorrhea TABLE I: TYPE OF EMERGENCY DERIVATION evoking cervix cancer, rectorragia or dysenteric syndrome Therapeutic attitude Number of Etiologies related to a rectal tumor.