Subcutaneous pyelovesical bypass – Detour bypass – as a solution for ureteric obstruction

Abstract

IntroductionMany patients suffer from unilateral or bilateral hydronephroses caused by pelvic tumors, retroperitoneal fibrosis, occlusion due to radiation therapy or iatrogenic damage to the ureter. Currently, percutaneous nephrostomy or double J stents are primarily used. Nephrostomy deteriorates a patient’s quality of life and leads to frequent infections, blockage of tubes, or bleeding, while uretral stents are associated with septicemia and irritative bladder symptoms. Thus, a useful solution is a Detour stent.Material and methodsA Detour stent consists of an outer layer made of polytetrafluoroethylene and an inner layer that is a silicone tube 17 F wide, with perforations on both ends and a radio-opaque ring on the proximal end. The ring allows for the insertion of the Detour to the kidney in the correct way. The Detour is placed subcutaneously to the kidney and to the bladder. The route is then tunneled by the large plastic hollow tube for inserting the Detour, and its distal end is sutured to the bladder.ResultsTwelve patients were operated using this method, one of which received a Detour stent bilaterally. The mean follow-up was 10 months. All patients were operated previously by different methods. The average time of surgery was 78 minutes. The following complications occurred: urinary tract infections, haematoma, obstructed flow of urine through the Detour stent, prolonged urinary leakage, and pyelonephritis.ConclusionsSubcutaneous nephrovesical bypass – Detour System – is a minimally invasive, safe and effective procedure that improves quality of life with no serious complications. The Detour System allows urine to be drained in those cases where many other treatments had failed or were not feasible.