Long-term results of the treatment of complex ureteral stenosis with extra-anatomic ureteral bypasses

Abstract

Introduction Complex ureteral obstruction is a pathology that has always been a challenge for the urologist, especially in patients with high surgical risk or with a short life expectancy. Material and methods Between 2002 and 2017, 13 extra-anatomical bypasses were placed. A descriptive retrospective study was carried out. An analysis of the permeability time of the prosthesis was performed using Kaplan-Meyer curves. Demographic and etiological characteristics as well as early and late complications were analysed. Results Etiologies were benign in 39% (including 3 transplant recipients) and malignant in 69%. Permeability rates were 90.9% at each of 12, 24 and 48 months, respectively, and 75.8% at 60 months. There were no deaths in the early postoperative period, nor intraoperative complications. The most frequent complications were infections. Three of them were associated with bypass extrusion, which needed to be removed. A total of 5 prosthesis had to be removed. 40% of the patients did not present complications. Conclusions The extra-anatomical ureteral bypass is an alternative to permanent nephrostomy in the treatment of complex ureteral strictures. Their patency rates after long-term follow-up vary from 90% to 75% at 48 and 60 months, respectively. Their complication rates can be considered acceptable in the patients’ clinical contexts.

Post-Transplant Ureteric Stricture Managed By Extra-Anatomical Stenting With Modification on the Originally Described Stent Location: A Case Report

“…While complex ureteral strictures can be treated with a variety of surgical options, several factors contribute to their success and should be considered in proper planning and management [8]. For instance, the treatment of ureteral stricture in patients with declining renal function and symptoms is traditionally decompression using a nephrostomy tube or stent, followed by a surgical repair [9].…”

“…Extra-anatomic bypass has a high patency rate of 90.9%, with no intraoperative complications. Stent infection was the most common long-term complication with a 38.5% rate, but the infection usually occurs after four years of implantation [8]. In complex kidney ureteric strictures, EAS displayed stable renal function for 32 months [14,15].…”