The detour extra-anatomic stent - a permanent solution for benign and malignant ureteric obstruction?

Objectives: We describe our experience of the Detour extra-anatomic stent (EAS) (Mentor-Porges, UK) for permanent bypass of complete upper urinary tract obstruction. The self-retaining expanded polytetra-fluoroethylene-silicone tube, placed in the kidney using a percutaneous route, is tunnelled under the skin and sutured into the bladder to establish extra- anatomical urinary drainage. Methods: From April 2002 to November 200S, a total of nine Detour stents were inserted into eight patients; one patient needed bilateral stent insertions. The causes for ureteric obstruction were persistent malignant disease in three and complicated benign disease in five patients. Results: To date, four of five patients with benign disease are alive; one died unexpectedly of metastatic malignancy. The only stent-related complications were infection and haematuria. The two patients with malignancy have subsequently died, but there were no urinary drainage problems for their second and third years of life, respectively. Conclusions: The preliminary data presented here suggest that the Detour EAS offers a permanent and minimally invasive method to establish internalisation of urinary drainage to bypass complete ureteric obstructions for which conventional stenting has failed, open surgery has been tried and failed or was not considered feasible, and long-term nephrostomy drainage was not favoured. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.