Circumvallating nephrocystostomy. A new approach to the treatment of obstructive nephropathy

For patients with obstructive nephropathy in whom a double J stent cannot be positioned, we have developed a new procedure which we call "circumvallating nephrocystostomy" (CNC). The method involves subcutaneous connection of a nephrostomy catheter and a suprapubic bladder catheter, which is inserted percutaneously. A total of 13 procedures have been performed in 9 patients (4 bilateral and 5 unilateral CNC); eight were cancer patients and one had ureteral necrosis. The CNC was in place for 44 days to 24 months. It was necessary to remove the CNC in one case because of obstruction and in another because of orchitis and recurrent cystitis. Two patients had obstruction of the CNC after 3 and 18 months, respectively, but in these cases the obstruction was treated successfully. Our results are encouraging enough to suggest CNC as a possible alternative to surgery in selected patients.