Department of Urology, Saint Camille Hospital, Bry-sur-Marne, France.
Department of Urology, Dupuytren Hospital, University of Limoges, Limoges, France.
Prog Urol. 2021 May;31(6):348-356. doi: 10.1016/j.purol.2020.12.016. Epub 2021 Jan 15.
We present the long-term results and complications of the DETOUR® prosthesis, a permanent subcutaneous pyelovesical bypass for the treatment of ureteral obstruction.
Between 2006 et 2018, 34 prosthesis were implanted in 28 patients (mean age 65,8 years) with ureteral obstruction of malignant or benign etiologies. The prosthesis, composed to an inner tube of silicone and an outer tube of expanded polytetrafluoroethylene, is placed subcutaneously between the kidney and the bladder. We are performed infrared spectrophotometry and scanning electron microscopy on two removed prostheses to explore the prosthetic encrustation.
The average follow-up was 25,8 months (Maximum: 64 months). Stent revision was required for early bladder fistula in three patients. The major long-term complications were infection (46%), obstruction (3 patients) and bladder fistula (7 patients). The most frequently infection are non-severe, but two patients died from septic shock after fungic colonization of the prosthesis. The infrared spectrophotometry and scanning electron microscopy analysis showed that the obstruction was favored by urinary infection and an alkaline medium. The functional prosthesis rate at 1,2 and 3 years was 94%, 71% and 62%, respectively.
The DETOUR® subcutaneous extra-anatomical urinary bypass is an effective and minimally invasive alternative to permanent percutaneous nephrostomy, for both malignant and benign ureteral obstructions in selected patients.
我们介绍了 DETOUR® 假体的长期结果和并发症，这是一种用于治疗输尿管梗阻的永久性皮下肾盂膀胱旁路术。
在 2006 年至 2018 年间，我们在 28 名患者（平均年龄 65.8 岁）中植入了 34 个假体，这些患者的输尿管梗阻具有恶性或良性病因。假体由硅酮内管和膨体聚四氟乙烯外管组成，放置在肾脏和膀胱之间的皮下。我们对两个已取出的假体进行了红外光谱和扫描电子显微镜检查，以探讨假体结垢的情况。
平均随访时间为 25.8 个月（最长：64 个月）。三名患者因早期膀胱瘘而需要更换支架。主要的长期并发症是感染（46%）、梗阻（3 名患者）和膀胱瘘（7 名患者）。感染大多不严重，但两名患者因假体真菌定植而死于感染性休克。红外光谱和扫描电子显微镜分析表明，梗阻受尿路感染和碱性介质的影响。1、2 和 3 年时的功能性假体率分别为 94%、71%和 62%。
DETOUR® 皮下非解剖性尿路旁路术是一种有效且微创的替代永久性经皮肾造口术的方法，适用于选定患者的恶性和良性输尿管梗阻。
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