Percutaneous implantation of subcutaneous prosthetic ureters: Long-term outcome

Purpose: We have used an extra-anatomic subcutaneous alloplastic ureteral r eplacement initially to bypass ureteral obstruction secondary to advanced p elvic malignancies in patients with a short life expectancy. Following the encouraging preliminary results, our list of indications has broadened to i nclude complex benign ureteral strictures. We herein report the long-term o utcome. Patients and Methods: A series of 35 subcutaneous prosthetic ureters were i mplanted percutaneously in 27 patients (19 unilateral and 8 bilateral) to b ypass extrinsic ureteral obstructions. The nature of obstruction was neopla stic in 22 patients and benign in 5. A composite prosthesis, consisting of two coaxial tubes-internal pure smooth silicone covered by coiled e-PTFE-ha s been designed to serve as the ureteral replacement. This tube is inserted percutaneously into the renal pelvis, tunnelled subcutaneously, and introd uced 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 mont hs for the deceased patients and 47 months for the surviving ones, the long est follow-up being 84 months. Results: No operative or immediate postoperative deaths were observed. Init ial difficulty in placing the prosthesis was encountered in 5 of the 27 pat ients (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 p atients because of local tumor progression with bladder fistulae. Five pati ents are alive with the prosthesis in place and a follow-up as long as 84 m onths without encrustation, infection, obstruction, or skin problems and wi th normally functioning kidneys. Conclusion: The subcutaneous urinary diversion using a silicone-PTFE prosth esis is an efficient and minimally invasive way to bypass malignant or comp lex benign obstructions of the ureters that otherwise would necessitate per manent nephrostomy drainage.