Management and treatment options when facing malignant ureteral obstruction

Area of Science:

• Urology
• Oncology
• Medical Devices

Background:

• Malignant ureteral obstruction presents a significant challenge due to limited survival and resistance to traditional treatments.
• Standard polymeric ureteral stents have a higher failure rate in malignant obstruction compared to benign causes.

Purpose of the Study:

• To review literature and provide a framework for managing malignant ureteral obstruction.
• To highlight the need for evidence-based guidelines and further research in this area.

Main Methods:

• Literature review and PubMed search using keywords such as "malignant ureteral obstruction" and various stent types.
• Analysis of existing studies, predominantly small and retrospective, focusing on alternative management options.

Main Results:

• A variety of alternative management options exist, including tandem stents, metallic stents, percutaneous nephrostomies, and extra-anatomic stents.
• The majority of available studies are small, retrospective, and often focus on metallic stents, making efficacy assessment difficult.

Conclusions:

• Current management of malignant ureteral obstruction is provider-dependent due to a lack of guidelines and prospective trials.
• Prospective, randomized clinical trials are essential to establish evidence-based medicine and develop clear guidelines for patient care.