Simultaneous bilateral subcutaneous pyelovesical bypass as a salvage procedure in refractory retroperitoneal fibrosis

Abstract

Ureteral obstruction causing renal failure is the most common complication associated with retroperitoneal fibrosis (RPF). Initial management includes steroid therapy together with ureteral stenting. When these fail, ureterolysis is the recommended surgical procedure. However, this could be challenging and recurrence is common. The aim of the present case series was to assess the feasibility of inserting simultaneous bilateral subcutaneous pyelovesical bypass grafts (SPBGs) in patients presenting with RPF who had failed initial endourologic/surgical management.

Feline ureteral obstructions Part 2: surgical management

“… , Haddad et al . ). However, urinary tract infection, Candida species positive urine cultures, fungal ball occlusion, stone occlusion, encrustation and death secondary to fungal infection‐induced septic shock have been described in association with the device.…”

“…Treatment strategies include balloon dilation, ureteral stenting, nephrostomy tube placement, ureteroneocystostomy, anastomosis to the native ureteral and intestinal grafting techniques (Andoinian et al 2005, Wheeless & Roenneburg 2005. If these options do not successfully resolve the stricture and ureteral obstruction, the use of nephrovesical SUB (Detour) has also been described for renal transplant recipients, with similar success rates for up to 15 years (Jabbour et al 2001, Desgrandchamps et al 2007, Azhar et al 2010, Haddad et al 2013). However, urinary tract infection, Candida species positive urine cultures, fungal ball occlusion, stone occlusion, encrustation and death secondary to fungal infection-induced septic shock have been described in association with the device.…”

Complete Occlusion of a Subcutaneous Pyelovesical Bypass Graft (Detour® System) Caused by Uric Acid Stone Formation

“…Later the indication was successfully extended to patients with ureteric strictures of transplant kidneys [5] . The first bilateral use in individuals with retroperitoneal fibrosis was reported in 2013 [3] . Several smaller case series showed good long-term results up to 15 years [6][7][8] .…”

“…Regarding stone formation, we only identified reports on two cases of stone-related SPBG obstruction. Both fragments could be extracted endoscopically [3,9] . Their compositional analyses revealed infect stones.…”

“…In August 2013 (11 months after implantation), grade 2 hydronephrosis was diagnosed by ultrasound. A CT scan confirmed total incrustation of the SPBG, and the patient was referred for endoscopic stone material extraction as published by other groups [3] . The creatinine level was not elevated.…”