Management of malignant ureteral obstruction in the palliative care setting

Acute renal failure due to bilateral ureteral obstruction is a common problem in palliative care. We report on two patients with advanced rectosigmold carcinoma in which bilateral malignant ureteral obstruction was managed by pharmacological and endourologic methods, respectively. The first patient showed excellent response to high-dose corticosteroids. The second patient showed no evidence of response and a urinary diversion procedure was performed. Indications for both pharmacological and endourological interventions in these patients are discussed. Our findings suggest that decision regarding the management of ureteral obstruction needs to be highly personalized and follow careful discussion with the patient and/or family.