Diagnosis and Management of Obstructive Uropathy in the Setting of Advanced Pelvic Malignancies

Abstract

Obstructive uropathy is a common urological problem, with a variety of etiologies, ranging from benign to malignant processes, extrinsic to intrinsic conditions. Its presentation depends largely on the location of the obstructive lesion and the acuity of the obstruction. Lower versus upper urinary tract obstruction present differently. A wide variety of imaging tools can aid in diagnosing the obstructive process and help delineate the etiology and the location of the obstruction. Treatment is geared towards alleviating the obstruction, either by restoring the normal urinary flow within the urinary tract by utilizing a ureteral stent for upper urinary tract obstruction, or urethral catheters for lower urinary tract obstruction or by diverting the urine by placing a percutaneous nephrostomy tube or suprapubic catheters. Pelvic malignancies are a subset of the many causes of obstructive uropathy and have unique considerations in treatment.  Future directions in the realm of management of obstructive uropathy should focus on maximizing urinary drainage while minimizing the morbidities associated with the current available treatment options.