Malignant Extrinsic Ureteral Obstruction: A Survey of Urologists and Medical Oncologists Regarding Treatment Patterns and Preferences

Objectives

To investigate and compare practice patterns regarding malignant extrinsic ureteral obstruction among urologists (GU) and oncologists (ONC).

Methods

We invited members of the American Urological Association and the American Society of Clinical Oncologists to participate in a web-based survey. Participants gave recommendations in clinical scenarios, as well as opinions regarding use of ureteral stents and nephrostomy tubes (PCN).

Results

The survey was randomly sent to 1500 GU and 1500 ONC, of whom 226 (15%) and 191 (12.4%) responded, respectively. The groups significantly varied in treatment preferences in all clinical scenarios. Regarding stent failure, ONC preferred PCN (79% versus GU 62%); GU (18% versus 5%) next preferred stent manipulation (eg, increase stent size, dual stents) (P <0.0001). The greatest risk of stents per GU was decreased quality of life (65% versus 13%), whereas ONC were most concerned about infection (43% versus 3%) (P <0.0001). The greatest risk of PCN per GU was dislodgement (48% versus 18%), whereas ONC were most concerned about infection (40% versus 8%) (P <0.0001).

Conclusions

Practice patterns vary significantly between GU and ONC in the treatment of malignant extrinsic ureteral obstruction. Further investigation and collaboration are necessary to determine which interventions are best for these patients and how to ensure consistency in their care.