Purpose: Malignant extrinsic ureteral obstruction (MEUO) is a challenging clinical problem. Many factors weigh into the decision to proceed with retrograde ureteral stent (RUS), nephrostomy tube (NT), or observation; however, there is no consensus for the optimal approach. The objective of this study was twofold. First, to determine practice patterns by correlating patient, hospital, and disease characteristics to manage MEUO; second, to describe treatment trends of MEUO over time. Materials and Methods: Using the National Inpatient Sample 2010–2015, we abstracted all adults with diagnoses of hydronephrosis and concurrent metastasis or lymphoma, excluding any record with a diagnosis of urinary tract stone. Multinomial regression assessed predictors of undergoing no decompression, stenting, or nephrostomy. Quarterly trends and annual percentage change of MEUO prevalence and percentage decompressed with stent vs nephrostomy were calculated. Results: There were an estimated 238,500 cases of MEUO from 2010 to 2015, of which 18.0% underwent decompression with RUS and 11.4% NT. On multinomial regression, prostate (odds ratio [OR] 1.5), bladder (1.6), cervical (1.6) cancer, academic hospitals (1.4), and acute kidney injury were among factors that most significantly increased odds of undergoing NT. Factors that significantly increased odds of undergoing RUS included colon (OR 1.4), rectal/anal (1.3), ovarian (1.2) cancer, Midwest ( vs northeast) hospitals (1.4), and female gender (1.4), whereas decreased odds of RUS were associated with bladder cancer (0.7), nonwhite race (0.8), and weekend admission (0.8). While MEUO prevalence has been increasing on an average of 2.9%/year, decompression rates have been decreasing, driven solely by a decrease in RUS of 3.8%/year on average. Conclusions: There is substantial variation in approach for MEUO among patient, hospital, and disease types, with an overall decline in stenting compared with steady nephrostomy use. Further investigation into best approaches for certain patient characteristics and disease types is needed to standardize care and reduce disparities.

Surgical management of clinically localized, high-risk prostate cancer is considered a standard of care, however there are known high rates of recurrence and need for adjuvant or salvage therapies. Neoadjuvant systemic therapies (hormonal, chemotherapeutic, immunotherapeutic, other) have been studied with the goal of improving surgical outcomes for these patients. Contemporary evidence does not yet support use of these therapies outside of clinical trials. Neoadjuvant hormonal therapy (NHT) has been shown to improve histopathological outcomes but not more rigorous clinical endpoints. Neoadjuvant docetaxel + hormone therapy has shown promise in phase II studies while phase III evidence is pending. There is ongoing research in the use of novel hormonal and immunotherapeutic agents in the neoadjuvant setting. Future research will determine which agents, alone or in combination, will provide benefit for patients, or subsets of patients, undergoing surgery for high-risk disease.