Page 47 - NEWSLETTER_19

Tεύχος 19 | Σεπτέμβριος - Οκτώβριος 2022
ΑΡΘΡΟ
occlusion and migration rates. DETOUR® bypass has been the treatment of choice for extra-anatomical ureteral diversion.
A series of 19 patients who had 27 prostheses inserted, assessed the QoL with EORTC QLQ-C30. An improvement of their functioning scale was showed as well as an improvement of their global QoL and satisfaction compared to previous diversion alternatives[1].
Another small series of 8 patients requiring extra- anatomical urinary diversion due to BUO and MUO reported no major complications except for infection and hematuria, significant QoL improvement and sustained results for up to 3 years of follow up [2].
In a couple of kidney transplantation series, ureteral stenosis has been encountered and extra-anatomical ureteric bypass has been performed. Limited testimonials demonstrate 32-month functionality associated with infection and encrustation [3]. Additionally, Mueller reported good and stable renal function after a mean follow up of 6 years (range 1 -14) [4].
DETOUR® is not a remedy for every patient. Complications might arise following the prosthesis implantation. Asymptomatic as well as symptomatic bacteriuria and sepsis are very common, especially in immunocompromised patients[4]. Luminal
obstruction due to uric acid stone formation[5] or fungal balls[6] can become evident. Patients with advanced pelvic malignancies or radiation cystitis might develop fistulae, either with neighboring organs or the skin[1]. Moreover, skin erosion might develop requiring revision[7]. One of the largest case series at present with 24 patients reported an overall 52% complication rate, mainly Clavien I - IIIb. Noteworthy is the fact that an explant of DETOUR® was performed in 26% of the cases. Similarly, Nouaille et al, in the largest series, reported 46% infection, 10% obstruction, 25% fistula rates with a functional prosthesis rate of 94%, 71% and 62% for years 1,2,3 respectively[8].
The latest high-quality evidence available that has investigated DETOUR® against other metallic and tumor stents failed to provide clear guidance on which one is the best choice for MUO and BUO treatment[9].
Concluding, it comes with reason that DETOUR® is a suitable and effective alternative to ureteric stents and nephrostomy tubes for malignant and benign cases of ureteric obstruction offering good quality of life but has to used in selected patients after balancing the risk of complications.
REFERENCES
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