Obstructive uropathy secondary to malignant ureteral strictures is rare, with carcinoma of the breast accounting for less than 2% of cases. We present the case of a woman in her late 50s with a history of breast cancer who developed bilateral ureteral obstruction. She presented with bilateral flank pain, vomiting, fever and reduced urine output, with a serum creatinine of 12 mg/dL. Imaging showed bilateral hydroureteronephrosis leading to percutaneous nephrostomy placement. Further investigation confirmed metastatic breast cancer causing ureteral strictures. The patient was treated with palliative radiotherapy. This case highlights the importance of considering malignant causes in patients with a history of cancer presenting with obstructive uropathy, emphasising the need for thorough diagnostic workup, including fluorodeoxyglucose-positron emission tomography scans, to guide appropriate management and avoid unnecessary surgical interventions. Early urinary diversion and targeted therapy are crucial for symptom relief and disease control.