Author's Response

In our article, there was a 100% success rate in the primary placement of percutaneous nephrostomies in patients presenting with malignant ureteric obstruction. Subsequently, only 19 of the 32 patients (59.4%) underwent a successful staged antegrade ureteric stent placement. This figure is lower than the 98% quoted by Chitale et al.¹ However, the number of patients in our study was rather small. Primary cystoscopic retrograde ureteric stent placement was not attempted in the management of any of the patient cohort in our study.

Overall, in our study, if the patient had not undergone any previous treatment for malignancy prior to presentation with malignant ureteric obstruction and, therefore, the prospect for future disease–related treatment existed, the median survival was 137 days. This fell dramatically to 76 days if the presentation with malignant ureteric obstruction was due to disease progression, with the patient already having undergone disease–specific treatment. This figure falls further to 60 days if the two patients with unaccountably long post–nephrostomy insertion survivals (711 and 814 days) are excluded. These figures are indeed longer than those proposed by Watkinson et al.² If, however, our data are stratified in a similar fashion to Watkinson et al.¹ our median survival is equally poor for patients with relapsed disease who received palliative treatment only following nephrostomy insertion (median survival, 42 days). These data were not included in our original paper and we apologise for any confusion that this omission may have caused. We would whole–heartedly support the statement by Drs Lane and Hines that the management of such patients needs to be individualised and discussed in front of a multidisciplinary team, before being able to offer the patient and his/her family balanced information to enable an informed decision on the merits of intervention.

We would also like to take this opportunity to thank Dr NG Warnock and Dr A Bowker, Consultant Radiologists at York Hospital, for their invaluable work in undertaking all of the percutaneous nephrostomy and antegrade ureteric stent placements in our paper. Again, we offer our apologies for their omission in the original paper.