Renal and urologic problems:  management of ureteric obstruction.
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Urology, University of Montreal Health Center (CHUM), Montreal, Quebec, Canada.
Daniel
D
Liberman
Michael
M
McCormack
D006801:Humans; D007674:Kidney Diseases; D009369:Neoplasms / Q000150:complications*; D010166:Palliative Care; D011379:Prognosis; D011788:Quality of Life; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D014547:Urinary Diversion / Q000379:methods*; D014570:Urologic Diseases