Project Summary

OPTIMISE MUO (prOsPecTIve MultIcentre Study investigating the managemEnt of patients with Malignant Ureteric Obstruction)

Urologists and Interventional Radiologists are frequently referred cancer patients with hydronephrosis secondary to malignant ureteric obstruction (MUO). This causes renal failure, severe pain, urosepsis, and may prevent cancer treatment or threaten life. Percutaneous nephrostomy (PCN) insertion*, and ureteric stenting (US)** can relieve obstruction. Both require regular tube exchanges in hospital, usually for the patient's remaining lifetime. 

Unlike other oncology emergencies such as metastatic spinal cord compression, no standardised care pathway exists for MUO and there is geographical variation in management approach. In addition, little is known about the patients that do not receive intervention. No data exists to explain why differing management decisions are made in patients with MUO. OPTIMISE MUO seeks to answer these questions.

OPTIMISE MUO is a prospective multicentre audit and will prospectively assess the rationale for intervention. It will also assess if that rationale is ultimately realised, and whether there are differences in how mode of intervention impacts on this. 

The OPTIMISE MUO methodology relies on a close working relationship between the study team and the local radiology and urology clinical teams (i.e case capture will be most effective if on call, inpatient, and outpatient reporting radiologists and on call urology teams know to flag MUO cases to the local OPTIMISE MUO study teams). It is for this reason that Consultant Radiologist and Urologist inclusion is mandatory in the local study team.

Identification of participants:

Local study leads will advertise the study to local Urology and Radiology Departments. Local radiologists will be asked to flag MUO cases to local study teams. Patients will also be identified from Urology and Interventional Radiology referrals for intervention. Diagnosis of MUO will be made as part of standard care. Patients will be identified over a 3-month study period and followed up at 3 month intervals for 9 months. 

Data collection

The RedCap software platform (https://projectredcap.org) will be utilised for data collection. Local teams will assess the reason for intervention: treatment path chosen, reason for approach, admission type (elective or emergency), details of further disease treatment planned. Follow-up data will include survival, renal function and readmissions (including reason for admission, elective or emergency, any interval changes to intervention approach along with oncological treatment status). Patients will continue to follow standard care throughout. Data in REDCap will be anonymised and so local teams will be required to keep a legend linking patient serial numbers to their identifiers (NHS no).

If you are interested in getting involved, please enter your details here: https://forms.gle/b6shT6VSRgZc38co8 or email MUOstudies@gmail.com for more information.

*Nephrostomy involves radiologically-guided insertion of a drain percutaneously into the obstructed kidney, under local anaesthetic. It’s often technically successful but frequently complicated by displacement, leaking, blockage and sepsis, long-term admission, and poor quality of life. 

**Ureteric stenting involves a cystoscopically inserted stent, usually under general anaesthetic. Insertion fails more often, and patients experience irritation symptoms. Complications include haematuria, infection, blockage, and longer-term failure.

Principal Investigators

Dr Oliver Llewellyn MRCS FRCR is an Interventional Radiology ST5 in Glasgow and RCR Kodak Research Fellow

Mr James Blackmur PhD FRCSEd(Urol) is a post-CCT Senior Clinical Fellow in Urology at Addenbrooke’s Hospital, Cambridge.

Mr Alexander Laird PhD FRCSEd(Urol) is a Consultant Urologist and Honorary Clinical Lecturer at The University of Edinburgh.

Mr Jonathan Aning FRCS(Urol) DM BM BS BMedSci is a Consultant Urologist at Bristol Urological Institute and Honorary Associate Professor at Bristol University