Nephrocutaneous bypass in ureteral obstruction.

OBJECTIVES

To describe our experiences with nephrocutaneous bypass and to assess the role of this procedure as a mean of urinary diversion in patients with incurable ureteral obstruction who are not appropriate candidates for subcutaneous pyelovesical bypass.

METHODS

Nephrocutaneous bypass was performed on 15 (12 male, 3 female) patients with incurable ureteral obstruction of malignant (n = 13; 87%) or benign (n = 2; 13%) etiology. Only patients with a significant disturbance of the bladder/sphincter-system were eligible for the procedure.

RESULTS

In total, 29 stents were applied using this technique. No major complications were observed perioperatively. The operating time for bilateral nephrocutaneous bypass was 74 (46-102) minutes and for unilateral bypass (1 patient) 38 minutes. Time of indwelling percutaneous nephrostomy before application of nephrocutaneous bypass was 190 (40-870) days. The patients who survived have a mean follow-up of 27 months, whereas for those patients who died the mean follow-up was 7.8 months. Nephrocutaneous bypass resulted in an improved renal function in all patients. Quality of life improvement was reported by all patients, and the objective criteria of "useful life" were met by 13 patients (87%).

CONCLUSIONS

Nephrocutaneous bypass is a safe and feasible method to provide effective pyelovesical drainage of urine in patients who have a short-term life expectancy, who are in poor general conditions, or otherwise would need a permanent nephrostomy drainage. The technique offers patients a higher mobility, increased independence resulting in higher quality of life during their final period of life, and may also be applied in nonmalignant patients after careful consideration of alternative urinary diversions.