The management of urinary tract obstruction in advanced pelvic disease

Malignancies invading the genito-urinary system can produce several distressing symptoms and life-threatening biochemical abnormalities. Uteretic obstruction can be caused by the disease of the urinary tract itself but also by diseases of the retroperitoneum, the gastro-intestinal tract, the female reproductive tract, and several vascular pathologies. Urinary tract obstruction can furthermore be iatrogenic in origin, caused by invasive surgery and radiotherapy. This chapter discusses the management of patients with obstruction of the urinary tract as a result of advanced gynaecological malignancy. Obstructive uropathy is common in patients with pelvic, retroperitoneal, and abdominal malignancies. Bladder outlet obstruction meanwhile is generally seen in patients with advanced cancers of the cervix, vulva, bladder, prostate, or urethra. Ureteric obstruction may result from the metastatic spread of ovarian, breast, prostatic, and bladder cancers. The focus of the chapter is on the practical aspects of the symptom control in these group patients, with emphasis on simple, problem-oriented management.