How do you decide between internal versus external decompression of malignant obstruction of the ureter (MUO)?

The decision between ureteral stenting and percutaneous nephrostomy placement is, by definition, an interdisciplinary one with my urologic oncology colleagues. If a ureteral stent is feasible, that typically is my preference as patients typically prefer this approach. Ultimately, the impact of local or systemic therapy improves or complicates the challenge.

For localized bladder tumor with curative therapy intent, we prefer neph tube to avoid the small potential risk of upper tract tumor spread (which was low based on a relatively moderate sample size study).

For metastatic disease, stent can be considered if feasible but a multi-disciplinary approach & Urology input are important.