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E.O.E Newsletter | www.huanet.gr
DETOUR® PROSTHESIS, A SUCCESSFUL EXTRA- ANATOMICAL URINARY DIVERSION OR SHOULD IT BE BYPASSED?
Γεώργιος Γεωργιάδης
Επιμελητής Β’ Ουρολογική Κλινική ΠΑ.Γ.Ν.Η.
INFO
ΑΡΘΡΟ
46
Ureteral stenosis is considered a huge challenge for a urologist in certain situations. A wide variety of clinical entities result in ureteral obstruction mainly
divided in malignant and benign causes. Malignant ureteric obstruction (MUO) is a consequence of malignant intrinsic or extrinsic compression. Benign ureteric obstruction (BUO) may result predominantly from stone disease, retroperitoneal fibrosis, radiotherapy, transplantation or iatrogenic causes. In any case, maintaining the drainage of the produced urine is the utmost goal, otherwise sepsis, pain or renal failure may undermine patients’ health.
Current treatment options are endoscopic, laparoscopic or open reconstructive surgery, various types of stents, nephrostomy tubes as well as extra-anatomical stenting. Deciding which technique is more appropriate and more beneficial for a patient introduces a clinical dilemma. The cause, the level of obstruction, life expectancy, failed previous treatments, patients’ choice and symptoms should guide surgeon’s right decision.
Extra-anatomical urinary diversion is a treatment option mainly for MUO but throughout the years has been utilized in other cases too. DETOUR® is an extra-anatomical, permanent, closed-system, reinforced tube that mediates urine drainage
from the renal cavities to the bladder. Its outer diameter is 9mm, the inner diameter is 5.8mm with a total length of 840mm. The inner surface is a silicone tube that is placed in the renal cavity as well as the bladder. Its biocompatible consistence prevents irritation as well as encrustation. The outer surface is a polyester sheath which promotes secure fixation with subcutaneous tissue anchoring the prosthesis in the desired place.
DETOUR® implantation can be accomplished with a minimally invasive technique, even under local anesthesia. A small incision is made in the flank and the proximal end is inserted in the renal pelvis up to the radiopaque ring that assists in proper placement. The distal end is inserted in the bladder after length customization through a small lower abdominal incision and a small cystotomy. The tunnel is made underneath the skin using the supplied tunneling device. Anchoring sutures are placed in the renal parenchyma and bladder wall.
Ensuring best QoL in patients, especially in palliative care setting is essential. Most of the times, ureteral stenting comes as the first choice but it might be either unsuccessful or rather irritative. If stenting is not applicable then a nephrostomy tube remains the quickest and safest solution. However, nephrostomies significantly impact patients’ QoL and daily activities in addition to high infection,