Treatment options

Bladder outlet obstruction causes symptoms of acute urinary retention or chronic obstruction, with overflow incontinence relieved by urethral or suprapubic catheterization. Palliative transurethral resection of a prostate or bladder tumour may be necessary to provide symptomatic relief. Ureteric decompression can be accomplished by:

♦ Percutaneous nephrostomy with or without antegrade stenting

♦ Cystoscopy and retrograde placement of an internal ureteric stent

Percutaneous nephrostomy is a temporary measure, appropriate in the following specific circumstances:

♦ Undiagnosed malignant disease

♦ Prostatic or cervical primary, with an available treatment modality with reasonable chance of response

Patients with advanced cancer can gain symptomatic benefit from nephrostomy/ureteric stent insertion. However, since a nephrostomy drain may remain in situ for several months, it is prone to dislodge-ment, infection, and leakage around the site. Double pigtail ureteric stents can be inserted in preference to a long-term nephrostomy. Complications of these include transient bacteremia, urosepsis, haemorrhage, and obstructive encrustations.

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