Dexamethasone in the management of acute lower ureteric obstruction by carcinoma of the prostate

Abstract

Aim: To assess the efficacy of dexamethasone in relieving acute lower ureteric obstruction by carcinoma of prostate. Patients and Methods: Over a four year period, 23 patients who presented with renal failure secondary to bilateral obstruction of the lower ureters by carcinoma of prostate, and with no significant bladder outlet obstruction, were treated, with dexamethasone for six weeks in addition to orchidectomy. The final outcome was retrospectively compared with that of 23 patients with similar condition managed in the unit within the past 15 years preceding the study, managed with only orchidectomy and no other specific treatment for carcinoma of the prostate or renal failure during the admission. Results: The 23 patients in the prospective study were aged between 58 and 82 years (mean 68 years). There was improvement in renal function in 21 patients within the first week of treatment, and this improvement was maintained in 20 of them even after discontinuation of dexamethasone therapy, and they survived for between 5 and 29 months (mean 15 months). One of the patients that initially responded, died 20 days after stopping the steroid therapy. In the remaining 2 patients, renal function rapidly deteriorated while on steroid therapy and they died 15 and 21 days respectively, after admission. In the retrospective study, six patients died within 10 days of admission and 17 survived for between 6 weeks and 9 months (mean 4.7 months). Conclusion: Dexamethasone in combination with orchidectomy seems to be more effective in the relief of acute obstructive nephropathy associated with lower ureteric obstruction by carcinoma of prostate than orchidectomy alone. It obviates the necessity for urinary diversion in such acutely ill patients.

Keywords

• prostate cancer
• bilateral ureteric obstruction
• dexamethasone