Which is better in patients with hydronephrosis before radical cystectomy—percutaneous nephrostomy versus internal ureteral stents

Urothelial bladder cancer (UBC) is the second most common type of malignancy in the urinary tract with high frequency of recurrence and high progression rate (1). European Urology Association (EAU) guidelines recommend radical cystectomy (RC) for muscle invasive bladder cancer or non-muscle invasive bladder cancer at highest risk of progression (2). Adjuvant chemotherapy after RC can be considered for high-risk M0 patients, such as pT3/4 and/or lymph node–positive disease (3). However, more than half of patients revealed hydronephrosis (HN) at time of RC and often require adjuvant chemotherapy. Cisplatin-based CTx, especially in patients with renal insufficiency, is a critical issue related to patient survival. For save renal function and treat HN, we may consider internal ureteral stenting (IUS) or percutaneous nephrostomy (PCN) tube insertion. Both procedures are well-established techniques for rapidly relieving ureteral obstruction and improving renal function. However, optimal management of malignant ureteral obstruction remains unclear before RC.