Malignant
ureteral obstruction is an unfortunate finding that can be caused by a wide-ranging number of
malignancies with a prognosis of limited survival. Given its presentation and progression, it can be refractory to treatment by traditional single polymeric ureteral
stents. With a higher failure rate than causes of benign
ureteral obstruction, a number of other options are available for initial management, as well as in cases of first-line
therapy failure, including tandem
stents, metallic
stents, percutaneous nephrostomies and extra-anatomic
stents. We reviewed the literature and carried out a PubMed search including the following keywords and phrases: "malignant
ureteral obstruction," "tandem ureteral
stents," "metallic ureteral
stents," "resonance
stent," "
metal mesh ureteral
stents" and "extra-anatomic
stents." The vast majority of studies were small and retrospective, with a large number of studies related to metallic
stents. Given the heterogenous patient population and diversity of practice, it is difficult to truly assess the efficacy of each method. As there are no guidelines or major head-to-head prospective trials involving these techniques, it makes practicing up to the specific provider. However, this article attempts to provide a framework with which the urologist who is presented with malignant
ureteral obstruction can plan in order to provide the individualized care on a case-by-case basis. What is clear is that prospective, randomized clinical trials are necessary to help bring evidence-based medicine and guidelines for patients with malignant
ureteral obstruction.