Morbidity and long-term results of subcutaneous pyelovesical bypass in chronic ureteral obstruction.
Adult
Aged
Aged, 80 and over
Chronic Disease
Female
Humans
Kidney Pelvis
/ surgery
Male
Middle Aged
Morbidity
Postoperative Complications
/ epidemiology
Retrospective Studies
Time Factors
Treatment Outcome
Ureteral Obstruction
/ surgery
Urinary Bladder
/ surgery
Urologic Surgical Procedures
/ methods
Young Adult
Obstruction urétérale
Pontage pyélo-vésical
Prothèse extra-anatomique
Prothèse urétérale
Pyelovesical bypass
Remplacement urétéral
Ureteral obstruction
Ureteral prosthesis
Ureteral replacement
extra-anatomic stent
Journal
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie
ISSN: 1166-7087
Titre abrégé: Prog Urol
Pays: France
ID NLM: 9307844
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
received:
17
08
2020
revised:
14
12
2020
accepted:
18
12
2020
pubmed:
19
1
2021
medline:
24
9
2021
entrez:
18
1
2021
Statut:
ppublish
Résumé
We present the long-term results and complications of the DETOUR® prosthesis, a permanent subcutaneous pyelovesical bypass for the treatment of ureteral obstruction. Between 2006 et 2018, 34 prosthesis were implanted in 28 patients (mean age 65,8 years) with ureteral obstruction of malignant or benign etiologies. The prosthesis, composed to an inner tube of silicone and an outer tube of expanded polytetrafluoroethylene, is placed subcutaneously between the kidney and the bladder. We are performed infrared spectrophotometry and scanning electron microscopy on two removed prostheses to explore the prosthetic encrustation. The average follow-up was 25,8 months (Maximum: 64 months). Stent revision was required for early bladder fistula in three patients. The major long-term complications were infection (46%), obstruction (3 patients) and bladder fistula (7 patients). The most frequently infection are non-severe, but two patients died from septic shock after fungic colonization of the prosthesis. The infrared spectrophotometry and scanning electron microscopy analysis showed that the obstruction was favored by urinary infection and an alkaline medium. The functional prosthesis rate at 1,2 and 3 years was 94%, 71% and 62%, respectively. The DETOUR® subcutaneous extra-anatomical urinary bypass is an effective and minimally invasive alternative to permanent percutaneous nephrostomy, for both malignant and benign ureteral obstructions in selected patients. 3.
Sections du résumé
BACKGROUND
BACKGROUND
We present the long-term results and complications of the DETOUR® prosthesis, a permanent subcutaneous pyelovesical bypass for the treatment of ureteral obstruction.
PATIENTS AND METHODS
METHODS
Between 2006 et 2018, 34 prosthesis were implanted in 28 patients (mean age 65,8 years) with ureteral obstruction of malignant or benign etiologies. The prosthesis, composed to an inner tube of silicone and an outer tube of expanded polytetrafluoroethylene, is placed subcutaneously between the kidney and the bladder. We are performed infrared spectrophotometry and scanning electron microscopy on two removed prostheses to explore the prosthetic encrustation.
RESULTS
RESULTS
The average follow-up was 25,8 months (Maximum: 64 months). Stent revision was required for early bladder fistula in three patients. The major long-term complications were infection (46%), obstruction (3 patients) and bladder fistula (7 patients). The most frequently infection are non-severe, but two patients died from septic shock after fungic colonization of the prosthesis. The infrared spectrophotometry and scanning electron microscopy analysis showed that the obstruction was favored by urinary infection and an alkaline medium. The functional prosthesis rate at 1,2 and 3 years was 94%, 71% and 62%, respectively.
CONCLUSION
CONCLUSIONS
The DETOUR® subcutaneous extra-anatomical urinary bypass is an effective and minimally invasive alternative to permanent percutaneous nephrostomy, for both malignant and benign ureteral obstructions in selected patients.
LEVEL OF EVIDENCE
METHODS
3.
Identifiants
pubmed: 33455824
pii: S1166-7087(20)30764-8
doi: 10.1016/j.purol.2020.12.016
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
348-356Informations de copyright
Copyright © 2021 Elsevier Masson SAS. All rights reserved.