Malignant ureteral obstruction (MUO) is an unpleasant finding resulting from a wide range of malignancies with limited survival prognosis. Its presentation and progression show that it can resist treatment with some stents, including single polymer ureteral stents. With most treatment failures, several treatments are available for the initial management and treatment of benign ureteral obstruction, including therapy with percutaneous nephrostomy (PCN), metallic stents, tandem stents, and other stents. Considering the variety of methods and the heterogeneous population of patients, evaluating the merit of each approach is challenging and needed. Due to the lack of significant studies in this field, these methods leave their performance up to the individual provider. This review aims to provide a framework for urologists to use for individual care and apply it appropriately to patients with MUO. Prospective clinical studies are needed to empower patients with MUO to receive evidence-based treatment and recommendations.