Trauma & Others(구연) (E-232) Clinical outcome after urinary diversion for the malignant ureteral obstruction secondary to non-urological cancer: analysis of 778 cases 연세대학교 의과대학 비뇨의학교실 ¹ 국민건강보험공단 일산병원 비뇨의학과 ² 허지은¹, 전대영¹, 이종수¹, 강숭구², 최영득¹, 장원식¹ Purpose: Urinary diversion for malignant ureteral obstruction (MUO) is performed not only for palliative care, but also to facilitate chemotherapy. However, there is lack of evidence to suggest significant improvement in outcomes in spite of technical advances in diversion. We investigate outcome after diversion and evaluate predictive factors for survival. Materials and Methods: We retrospectively reviewed patients with non-urological malignancies who underwent urinary diversion for MUO by ureteral stenting or percutaneous nephrostomy (PCN) between 2006 and 2014. We excluded patients who previously underwent urological surgeries or had bladder invasion. The variables for predicting overall survival were identified by Cox regression analysis. Results: Of 778 patients, 522 stent and 256 PCN were included. Renal function was recovered immediately and at 2 weeks after urinary diversion (all p<0.001). The median survival was 5 months (IQR 2-12) and 708 patients died. The survival rates at 1, 3, 6, and 12 months were 75.8%, 58.8%, 43.7% and 25.0%, respectively. Patients who have performed chemotherapy after diversion had a survival gain of 7 months compared to patients without subsequent chemotherapy (p<0.001). Type of diversion was not related with survival (p=0.451). Male gender, previous chemotherapy without radiation therapy, increasing number of events related to malignant dissemination, preoperative low hemoglobin (<10 mg/dL), low albumin (<3 g/dL), low estimated glomerular filtration rate (<60 ml/min/1.73m2), not following chemotherapy or radiation therapy were significantly associated with short survival. Conclusion: In ureteral obstruction with non-urological malignancies, the overall survival was poor. However, good renal function before procedure and subsequent therapies were related with better survival. Therefore, regardless of type, urinary diversion can be considered aggressively to preserve renal function for primary cancer treatment. keywords : malignant ureteral obstruction, survival, urinary diversion