Genitourinary and other primary malignancies cause frequent and common urogenital complications. Healthcare providers need to be cognizant of these unique problems inherent in treating cancer patients. In this chapter, we will discuss the most common urogenital complications of patients with cancer.
Primary malignancies can spread from their original location to the retroperitoneum and lead to ureteral obstruction. The obstruction typically occurs from either direct extension from the tumor itself or metastases to the retroperitoneal lymph nodes. Malignancies originating from the genitourinary system are the most common cause of ureteral obstruction in patients with cancer. However, other malignant tumors can be culprits (Table 57.1). Additionally, other therapies such as radiation therapy can result in ureteral obstruction.
Patients with ureteral obstruction typically present with flank pain, oliguria, or azotemia. Renal sonography, abdominal-pelvic computed tomography (CT) scan, or intravenous pyelogram (IVP) usually demonstrate unilateral or bilateral hydronephrosis in patients with significant ureteral obstruction.
Internal double-J stents, placed in a retrograde fashion through the bladder and into the renal pelvis, usually relieve the obstruction. Occasionally, significant retroperitoneal disease precludes the placement of internal stents. In these situations, percutaneous nephrostomy tubes placed into the kidneys relieve the obstruction.
Patients may exhibit a marked polyuria following the relief of bilateral ureteral obstruction. This postobstructive diuresis is usually physiologic and self-limited. If the polyuria is persistent and associated with elevation of serum creatinine and blood urea nitrogen (BUN), the patient needs aggressive monitoring of urine output, blood pressure, intravenous fluids, and serum electrolytes.