Nephrovesical subcutaneous stent: an alternative to permanent nephrostomy

Area of Science:

• Urology
• Oncology
• Surgical Innovation

Background:

• Ureteral obstruction due to pelvic malignancy presents a significant clinical challenge.
• Permanent nephrostomy tubes are a common management strategy but are associated with high complication rates and frequent rehospitalizations.
• Previous attempts at Double-J stent insertion may have failed in complex cases.

Purpose of the Study:

• To evaluate the efficacy and safety of a subcutaneous ureteral bypass as an alternative to permanent nephrostomy tubes.
• To assess the suitability of this bypass in patients with ureteral obstruction caused by pelvic malignancy.

Main Methods:

• A specially designed nephrovesical stent was inserted into subcutaneous tissue under local anesthesia.
• The stent comprises two J-stents connected after placement in the renal pelvis and bladder.
• The procedure was performed in patients with obstructed ureters due to metastatic prostate or invasive bladder cancer.

Main Results:

• Ten subcutaneous stents were successfully inserted in 8 patients as a replacement for permanent nephrostomy tubes.
• The bypass demonstrated successful function in all cases throughout the follow-up period (6 weeks to 18 months, mean 5.5 months).
• This method was employed when standard Double-J stent insertion had previously failed.

Conclusions:

• The subcutaneous ureteral bypass presents a viable and less invasive alternative to permanent nephrostomy tubes.
• Eliminating external drainage devices significantly enhances patient quality of life.
• This technique offers a valuable option for managing ureteral obstruction in challenging oncological cases.