title: The management of ureteric obstruction secondary to malignant pelvic disease.
abstract: OBJECTIVE
  Management of upper-tract obstruction secondary to a malignant pelvic process is a difficult problem and is best dealt with by a multi-disciplinary team. In the present audit, we address the question: is staged antegrade stenting better than retrograde ureteric stenting?
  
  
  METHODS
  We reviewed our present management of upper-tract obstruction secondary to malignant pelvic disease in 65 patients treated over a period of 2 years. Fifty-eight patients had urological cancer and seven patients had non-urological cancers; 70% of all cases had renal impairment. Twenty-four of 65 patients had an attempt at endoscopic retrograde ureteric stenting as a primary method of decompression while percutaneous nephrostomy followed by antegrade ureteric stenting was performed in 41/65 patients.
  
  
  RESULTS
  Endoscopic retrograde stenting had a success rate of 21% whereas two-stage antegrade stenting was successful in 98% of patients. The antegrade approach had minimal morbidity.
  
  
  CONCLUSIONS
  Obstruction of the pelvic ureter secondary to any pelvic malignancy is best managed by two-stage antegrade ureteric stenting. This approach has a high success rate with minimal morbidity, and should be preferred to an endoscopic approach. This highlights the important role of an interventional uroradiologist in the management of these patients.
authors.affiliation: Department of Urology, Norfolk & Norwich University Hospital NHS Trust, Brunswick Road, Norwich, Norfolk, NR1 3SR, UK. chitalenorwich@aol.com
authors.forename: S V
authors.initials: SV
authors.lastname: Chitale
authors.forename: S
authors.initials: S
authors.lastname: Scott-Barrett
authors.forename: E T S
authors.initials: ET
authors.lastname: Ho
authors.forename: N A
authors.initials: NA
authors.lastname: Burgess
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D010386:Pelvic Neoplasms / Q000150:complications*; D012004:Rectal Neoplasms / Q000150:complications; D015607:Stents; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D014565:Urogenital Neoplasms / Q000150:complications