Given the current stage of the disease, will surgery be reasonable option once the hydronephrosis is relieved by nephrostomies ?
No. At the time of writing (2011-2012) stage IIa is considered the crucial separator between deciding whether a case is suitable for surgery (below stage IIa) or chemo-radiation (IIa or above). This patient has stage IV disease!
Bilateral percutaneous nephrostomy tubes under ultrasound and fluoroscopic guidance.