Extra-anatomic stents in ureteric obstruction: experience and complications

Objective. To assess the role of extra-anatomic stents (EAS) as a means of urinary diversion in patients with ureteric obstruction secondary to malign ancy. Patients and methods. The technique for inserting EAS in patients with uret eric obstruction was described previously: to date, 13 patients (seven wome n and six men, mean age 45.3 years, range 22-78) have been treated. All pat ients had ultrasonographic evidence of hydronephrosis and/or significant bi ochemical evidence of renal impairment. Patients had advanced malignancy an d one patient an abdominal aortic aneurysm. Results Urinary diversion was successful in all patients; two survived for more than 1 year, with stent changes at 6-monthly intervals. In three patie nts the stents were replaced by percutaneous nephrostomies because of probl ems with leakage or infection. The remaining patients died with functioning EAS in situ. Conclusions In patients with ureteric obstruction secondary to malignancy o r medical conditions excluding them from more invasive surgery, EAS provide a further therapeutic option instead of a permanent nephrostomy, which has associated inherent problems. This technique is not without potential prob lems and careful selection of patients remains vital in this difficult area .