Skip to main content
SpringerLink
Log in

Langzeitergebnisse zur subkutanen Detour ®-Harnleiterprothese bei Ureterobstruktion

Erfahrungen zu Implantation, Nachsorge und Komplikationsmanagement

Long-term results for subcutaneous Detour® prosthesis for ureteral obstruction

Experiences of implantation, aftercare and management of complications

  • Originalien
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Wir stellen Langzeitergebnisse der Anwendung des Detour®-Systems als Alternative zu etablierten operativen Ureterersatzmethoden bzw. perkutanen oder inneren Harnableitungen vor.

Material und Methoden

Zwischen 2004 und 2012 wurden 40 Systeme, z. T. beidseits, bei 31 Patienten (Durchschnittsalter 65 Jahre) mit Ureterpathologika unterschiedlicher Genese implantiert. Die Nachsorge umfasste Untersuchungen und Fragebögen.

Ergebnisse

Die durchschnittliche Nachsorge lag bei 23 (1–92) Monaten. Sonographische Kontrollen zeigten bei 38/40 implantierten Systemen keine Harnstauung. Die Retentionswerte waren bei 19 Patienten stabil, bei 7 verbessert, bei 3 verschlechtert. Die Lebensqualität (LQ) der Patienten war hoch (QLQ-C30 90%). Intraoperative Komplikationen waren: 2 Darmläsionen und 3 Einblutungen des Systems/Nierenbeckens. Postoperativ traten Wundheilungsstörungen und Harnweginfekte auf. Im Langzeitverlauf traten 3 infizierte Harnstauungsnieren auf, die unter passagerer Nephrostomie und Antibiose ausheilten. Vier Systeme wurden explantiert, darunter 2 Wechsel.

Schlussfolgerungen

Das System kann bei Patienten mit Ureterstrikturen in palliativer und kurativer Zielsetzung erwogen werden. Es bestehen keine wesentlichen Nachteile im Vergleich mit etablierten Verfahren bei deutlich risikoärmerer Implantation und beherrschbaren Komplikationen. Die Lebensqualität wird deutlich gebessert.

Abstract

Background

We present the long-term results of implementation of the Detour® prosthesis as an alternative to established methods of surgical, percutaneous or internal urinary diversion.

Patients and methods

Between 2004 and 2012 a total of 40 prostheses were implanted in 31 patients (mean age 65 years) with ureteral strictures of various origins. In the follow-up the patients underwent examinations and completed questionnaires.

Results

The average follow-up was 23 months (range 1-92 months). Sonographic examinations showed no urinary retention in 38 out of 40 implanted systems. The retention values were stable in 19 patients, improved in 7 and worse in 3. The quality of life (QoL) was high (EORTC QLQ-C30 90%). Intraoperative complications were 2 intestinal lesions and 3 bleeding of the renal-pelvic system. Postoperative urinary tract infections and wound complications were encountered. In the long-term course three infected hydronephroses occurred which were treated and cured with antibiotics and temporary nephrostomy and 4 systems were explanted, including 2 exchanges.

Conclusions

The system may be considered for patients with ureteral strictures with palliative and curative intent. There were no significant disadvantages in comparison with established methods. There were fewer risks in implantation and complications were manageable. The quality of life was significantly improved.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Kouba E, Wallen EM, Pruthi RS (2008) Management of ureteral obstruction due to advanced malignancy: optimizing therapeutic and palliative outcomes. J Urol 180:444–450

    Article  PubMed  Google Scholar 

  2. Schulman CC, Vandendris M, Vanlanduyt P, Abramow M (1976) Total replacement of both ureters by protheses. Eur Urol 2:89–91

    PubMed  CAS  Google Scholar 

  3. Marberger M (2006) Prosthetic nephrovesical bypass. Eur Urol 50:879–883

    Article  PubMed  Google Scholar 

  4. Nissenkorn I, Gdor Y (2000) Nephrovesical subcutaneous stent: an alternative to permanent nephrostomy. J Urol 163:528–530

    Article  PubMed  CAS  Google Scholar 

  5. Desgrandchamps F, Cussenot O, Meria P et al (1995) Subcutaneous urinary diversions for palliative treatment of pelvic malignancies. J Urol 154:367–370

    Article  PubMed  CAS  Google Scholar 

  6. Desgrandchamps F, Duboust A, Teillac P et al (1998) Total ureteral replacement by subcutaneous pyelovesical bypass in ureteral necrosis after renal transplantation. Transpl Int 11(Suppl 1):150–151

    Google Scholar 

  7. Desgrandchamps F, Paulhac P, Fornairon S et al (1998) Artificial ureteral replacement for ureteral necrosis after renal transplantation: report of 3 cases. J Urol 159:1830–1832

    Article  PubMed  CAS  Google Scholar 

  8. Burgos FJ, Bueno G, Gonzalez R et al (2009) Endourologic implants to treat complex ureteral stenosis after kidney transplantation. Transplant Proc 41:2427–2429

    Article  PubMed  CAS  Google Scholar 

  9. Lloyd SN, Tirukonda P, Biyani CS et al (2007) The Detour extra-anatomic stent—a permanent solution for benign and malignant ureteric obstruction? Eur Urol 52:193–198

    Article  PubMed  Google Scholar 

  10. Desgrandchamps F, Leroux S, Ravery V et al (2007) Subcutaneous pyelovesical bypass as replacement for standard percutaneous nephrostomy for palliative urinary diversion: prospective evaluation of patient‘s quality of life. J Endourol 21:173–176

    Article  PubMed  Google Scholar 

  11. Jabbour ME, Desgrandchamps F, Angelescu E et al (2001) Percutaneous implantation of subcutaneous prosthetic ureters: long-term outcome. J Endourol 15:611–614

    Article  PubMed  CAS  Google Scholar 

  12. Loertzer H, Jurczok A, Wagner S, Fornara P (2003) Der künstliche pyelovesikale und pyelokutane Bypass: Ein palliatives Therapiekonzept bei tumorbedingter chronischer Harnstauung. Urologe A 42:1053–1059

    Article  PubMed  CAS  Google Scholar 

  13. Würnschimmel E (2003) Erste Erfahrungen mit der subkutanen Harnableitung bei der palliativen Therapie von Ureterobstruktionen. J Urol Urogynäkol 10:16–22

    Google Scholar 

  14. Kimuli M, Sciberras J, Lloyd S (2010) Extra-anatomic urinary drainage for urinary obstruction. Chronic kidney disease. ISBN 978-953-51-07171-0, pp 281–296, http://www.intechopen.com

  15. Matlaga BR, Shah OD, Hart LJ, Assimos DG (2003) Ileal ureter substitution: a contemporary series. Urology 62:998–1001

    Article  PubMed  Google Scholar 

  16. Wolff B, Chartier-Kastler E, Mozer P et al (2011) Long-term functional outcomes after ileal ureter substitution: a single-center experience. Urology 78:692–695

    Article  PubMed  Google Scholar 

  17. Kocot A, Vergho DC, Riedmiller H (2012) Harnleiterersatz unter Verwendung von Darmsegmenten. Urologe 51:928–936

    Article  PubMed  CAS  Google Scholar 

  18. Bynens BG, Ampe JF, Denys H, Oyen PM van (2006) Relief of acute obstruction of the Detour subcutaneous pyelovesikal bypass. J Endurol 20:669–671

    Article  Google Scholar 

  19. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  Google Scholar 

  20. Vallejo HJ, Maganto PE, Burgos RFJ et al (1999) The double-J ureteral catheter: its historical development and current status. Arch Esp Urol 52(5):499–504

    Google Scholar 

  21. Vallejo Herrador J, Burgos Revilla FJ, Maganto Pavón E et al (1997) The double-J ureteral catheter. Clinical indications. Arch Esp Urol 50(10):1089–1097

    Google Scholar 

  22. Adamo R, Saad WE, Brown DB (2009) Percutaneous ureteral interventions. Tech Vasc Interv Radiol 12(3):205–215

    Article  PubMed  Google Scholar 

  23. Galal H, Lazica A, Lampel A et al (1993) Management of ureteral strictures by different modalities and effect of stents on upper tract drainage. J Endourol 7(5):411–417

    Article  PubMed  CAS  Google Scholar 

  24. Richter F, Irwin RJ Jr, Watson RA, Lang EK (2000) Endourologic management of malignant ureteral strictures. J Endourol 14(7):583–587

    Article  PubMed  CAS  Google Scholar 

  25. Richter F, Irwin RJ, Watson RA, Lang EK (2000) Endourologic management of benign ureteral strictures with and without compromised vascular supply. Urology 55(5):652–657

    Article  PubMed  CAS  Google Scholar 

  26. Pauer W (2002) Selbstexpandierende permanente endoluminale Stents (SPES) zur Therapie der benignen Harnleiterobstruktion. Urologe A 41:267–272

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehung/en hin: Der korrespondierende Autor gibt an, Vortragshonorare von Coloplast erhalten zu haben.

Author information

Authors and Affiliations

  1. Universitätsklinik für Urologie und Kinderurologie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Straße 44, 39120, Magdeburg, Deutschland

    A. Janitzky, J. Borski, M. Porsch, J.J. Wendler, D. Baumunk, U.-B. Liehr & M. Schostak

Authors
  1. A. Janitzky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Borski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Porsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J.J. Wendler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Baumunk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. U.-B. Liehr
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Schostak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Janitzky.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Janitzky, A., Borski, J., Porsch, M. et al. Langzeitergebnisse zur subkutanen Detour ®-Harnleiterprothese bei Ureterobstruktion. Urologe 51, 1714–1721 (2012). https://doi.org/10.1007/s00120-012-3039-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-012-3039-7

Schlüsselwörter

Keywords

Search

Navigation