Abstract | PURPOSE: We have used an extra-anatomic subcutaneous alloplastic ureteral replacement initially to bypass ureteral obstruction secondary to advanced pelvic malignancies in patients with a short life expectancy. Following the encouraging preliminary results, our list of indications has broadened to include complex benign ureteral strictures. We herein report the long-term outcome. PATIENTS AND METHODS: A series of 35 subcutaneous prosthetic ureters were implanted percutaneously in 27 patients (19 unilateral and 8 bilateral) to bypass extrinsic ureteral obstructions. The nature of obstruction was neoplastic in 22 patients and benign in 5. A composite prosthesis, consisting of two coaxial tubes--internal pure smooth silicone covered by coiled e- PTFE--has been designed to serve as the ureteral replacement. This tube is inserted percutaneously into the renal pelvis, tunnelled subcutaneously, and introduced through a small suprapubic incision in the bladder. All patients were followed to date or until death from tumor. The mean follow-up was 6.3 months for the deceased patients and 47 months for the surviving ones, the longest follow-up being 84 months. RESULTS: No operative or immediate postoperative deaths were observed. Initial difficulty in placing the prosthesis was encountered in 5 of the 27 patients (19%). Secondary parietal complications occurred in 8.5% of cases (3/35). The prosthetic ureter had to be removed in one patient because of skin erosion. Return to a standard percutaneous nephrostomy was needed in two patients because of local tumor progression with bladder fistulae. Five patients are alive with the prosthesis in place and a follow-up as long as 84 months without encrustation, infection, obstruction, or skin problems and with normally functioning kidneys. CONCLUSION:
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Authors | M E Jabbour, F Desgrandchamps, E Angelescu, P Teillac, A Le Duc |
Journal | Journal of endourology
(J Endourol)
Vol. 15
Issue 6
Pg. 611-4
(Aug 2001)
ISSN: 0892-7790 [Print] United States |
PMID | 11552786
(Publication Type: Journal Article)
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Prosthesis Implantation
(adverse effects)
- Reoperation
- Treatment Outcome
- Ureter
(surgery)
- Ureteral Obstruction
(surgery)
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