Subcutaneous Urinary Diversion: An Alternative to Percutaneous Nephrostomy

Abstract

Nephrostomy has been the standard method of urinary diversion when placement of ureteral stents has failed in cancer patients. We describe our early experience with an alternative method of urinary diversion, the subcutaneous urinary diversion. This extra-anatomical urinary diversion was done in 5 patients during a 15-month interval. The diversion is created using a specially designed 7F double pigtail stent. The proximal end of the stent is inserted into the renal pelvis via a percutaneous nephrostomy puncture. A subcutaneous tunnel is created from the flank to the bladder down which the distal end of the stent is passed and via a suprapubic bladder puncture the stent is passed into the bladder. The stent is changed at 4-month intervals over a guide wire. Our early experience with this extra-anatomical method of urinary diversion suggests it to be a safe, effective and acceptable alternative to nephrostomy that improves quality of life.

Subcutaneous Nephrovesical and Nephrocutaneous Bypass

“…As an alternative to permanent nephrostomy, several authors published results of a subcutaneous nephrovesical stent system [15][16][17][18] . Similar to the system described here the cranial end of a closed stent system is placed in the renal pelvis, the distal end is tunneled subcutaneously and inserted into the bladder by suprapubic puncture.…”

Extra-Anatomic Urinary Drainage for Urinary Obstruction

“…The diversion was created using a specially designed 7F double pigtail stent, which they routinely changed at 4-month intervals. They found it to be a safe, effective and an acceptable alternative to nephrostomy drainage that improved quality of life (Lingam et al, 1994). A year later, another small study reported a marked improvement in patients' overall comfort and quality of life following conversion of nephrostomies to EASs using a similar but slightly larger 8.5F stent (Nakada et al, 1995).…”

“…Different types of EAS have been developed and used successfully by different authors (Lingam, 1994;Minhas, 1999;Desgrandchamps, 1998a;, Lloyd, 2007). The designs have varied with the materials used, length of stent, diameter of stent and on whether one or composite stent/s are utilized.…”

“…This landmark study resulted in rapid progress in the investigation for potential materials for ureteric replacement that could be used without need for major reconstructive surgery. However, it was not until 1994 that the first viable 7F double-pigtail prosthetic extra-anatomic bypass system was developed (Lingam et al, 1994). Despite several series reporting excellent outcomes during the last two decades, extraanatomic stenting is not yet universally offered to candidate patients.…”

“…Several authors have reported their experience of using extra-anatomical stents (EAS) for temporary or permanent drainage of obstructed urinary tracts (Ahmadzadeh, 1991;Lingam et al, 1994;Nakada et al, 1995;Desgrandchamps et al, 1998aDesgrandchamps et al, 1998bMinhas et al, 1999;Lloyd et al, 2007). In this chapter, we describe the indications for and the technique of inserting the EAS, and a review of the results from the major series.…”