Episode 431: Oncologic Emergencies 101: Urinary Obstruction

“Think about all the important things our kidneys do for the body. Those things are compromised. If we have excess buildup of toxins and waste in the body, you’re having problems with fluid reabsorption. Then you have also problems with electrolytes not being balanced. Then in turn, you have ongoing shutdown of systems. So the cardiopulmonary system gets compromise. Your circulatory system then gets compromised. And then all the things in the body that depend upon ongoing circulatory flow are then causing major resets in the system that need to be addressed,” ONS member Brenda S. Nettles, DNP, MS, ACNP-BC, AOCNP, CNE, assistant professor at the Johns Hopkins School of Nursing and nurse practitioner at Johns Hopkins Hospital in Baltimore, MD, told Madeline Johnston, MSN, RN, OCN^®, oncology clinical specialist at ONS, during a conversation about urinary obstructions.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.25 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by September 4, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge relating to urinary obstruction as an oncologic emergency.

Episode Notes 

• Complete this evaluation for free NCPD. 
• ONS Podcast™ episodes:
• Oncologic Emergencies 101 series
• Episode 424: Radiation Site-Specific Side Effects: Cancers of the Pelvis
• Episode 394: Prostate Cancer Survivorship Considerations for Nurses
• Episode 390: Prostate Cancer Treatment Considerations for Nurses
• Episode 387: Prostate Cancer Screening, Early Detection, and Disparities
• ONS Voice articles:
• A Primer on Urothelial Cancer
• Oncology Urgent Care Provides the Right Place, Right Time, and Right Treatment for Patients Experiencing Cancer-Related Emergencies
• In the Event of an Oncologic Emergency, Make Sure You’re Prepared to Deliver Compassionate, Life-Saving Care
• ONS book: Understanding and Managing Oncologic Emergencies: Traditional and Emerging
• ONS course: ONS Oncologic Emergencies™
• ONS Oncologic Emergencies Learning Library
• American Cancer Society anatomy galleries:
• Female Genitourinary System
• Male Genitourinary System

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

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Highlights From This Episode

“As far as diagnoses go, I think that the ones that we see most common are impacted by the actual genitourinary system itself being impacted, so your patients with prostate cancer and patients with bladder cancer are definitely the ones that we see most often. But you’ll see that it’s also in individuals that have a diagnosis of either mucinous neoplasms or invasive peritoneal disease that invades all the cavities of the body—and also your sarcomas, because they also will actually the involve different parts of the renal system as part of their spread pattern.” TS 3:55

“The first thing you want to do is try to eliminate the causative factor. So what’s causing the obstruction? If there’s something that’s limiting flow because of the compression from the outside of the ureter or compressing around the kidney itself that they can’t drain adequately, then you can look at ways to manage that by inserting a nephrostomy tube into the kidney. You can also put in ureteral stents to help alleviate the pressure from drainage from the kidney to the ureter and into the bladder.” TS 7:20

“It’s very common when people have a partial obstruction to have still some degree of urinary output. But the key thing is looking at, over time, how that may change. So if they do develop some progressive symptoms of the flank pain, and then also renal function begins to get a little bit lower and lower over time. Hematuria or signs of infection—those are again that next-level discussion that needs to be had about what gets evaluated next to confirm a possible obstruction.” TS 10:00

“The biggest misconception, I believe, would be that you have time to figure it out. And the individual that already has immunocompromised states and also possible decline in baseline renal function have very low thresholds for us to really wait on these things too long. It’s always better to err on the side of caution and do at least the due diligence of minimal evaluation by looking at the individual’s vital signs and looking at their ability to still have urine output. Then if that’s now compromised, work further into the process in a more timely manner.” TS 13:47

“It’s always good to have a refresher about how to manage different types of urinary diversion systems, so check with your facility in regards to what they carry for nephrostomy tube devices and the maintenance plans they have for those as far as frequency of flushing. So you can be a problem solver for your individual that has these diversion devices place for urinary obstructions.” TS 16:19