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Obstructive Uropathy — SCE Medical Oncology MCQ

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ModerateOncological EmergenciesObstructive UropathySCE Medical Oncology

A 62-year-old man with cancer develops acute bilateral leg swelling and anuria. CT shows bilateral ureteric obstruction from retroperitoneal lymphadenopathy. Creatinine is 650 µmol/L. What is the emergency management?

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Correct answer: D — Urgent bilateral nephrostomy insertion (or ureteric stenting) to relieve obstruction — this is an obstructive uropathy emergency requiring decompression before any chemotherapy can be safely given

Malignant ureteric obstruction causing obstructive uropathy is an oncological emergency requiring urgent urological decompression (percutaneous nephrostomy or retrograde ureteric stenting). Failure to decompress leads to irreversible renal damage. Once renal function recovers (may take days-weeks), definitive cancer treatment (chemotherapy, radiotherapy) can be administered. Post-obstructive diuresis (massive polyuria) may occur after decompression, requiring careful fluid balance management. Haemodialysis may be needed as a bridge.

Reference: ESMO Oncological Emergencies; NICE Acute kidney injury; NICE NG