Renal and urologic problems: Management of ureteric obstruction

Purpose of review The purpose of this article is to review the recent literature concerning obstructive uropathy from advanced cancer. This factor is relevant as it is often a difficult task for physicians to estimate a patient's life expectancy and evaluate the possible benefit of urinary diversion. Recent research has addressed this issue. We now have objective criteria to stratify the possible benefit of urinary diversion in patients with malignant obstructive nephropathy. Recent findings When dealing with ureteric obstruction treatment must be individualized and risk stratification is of paramount importance. There is no clear evidence that urinary diversion improves quality of life and treatment decisions must be individualized. The decision to treat obstructive nephropathy in the palliative setting should include the patient, his family and members of the support team. Summary Ureteric stents and percutaneous nephrostomies are the preferred initial treatment options, although stent infection, encrustation and blockages are common problems. New compression-resistant metallic stents seem promising for patients with a malignant disease who require long-term urinary drainage. When more conservative measures have failed, supra-vesical reconstruction and diversion may be an option.