Reconstruction: Malignant

Moderated Poster Session

MP14-11 - Extranatomical Urinary Diversion with the Detour™ for the treatment of complex ureteric stenosis: preliminary experience with 17 cases.

Saturday, September 22
10:00 AM - 12:00 PM
Location: Room 241

Introduction & Objective : The Extra Anatomical Urinary Diversion (EAUD) is a subcutaneous urinary diversion that reestablishes the connection between the renal pelvis and urinary bladder.  This device was originally used as a palliative treatment of ureteral obstructions secondary to terminal malignancies or in case of refractory ureteral strictures in kidney transplants. We present our experience with the Detour™ system as a treatment in patients with malignant strictures with the aim to improve their quality of life but also as a definitive solution in selected patients affected by benign complex ureteral stenosis when other treatments have failed.


Methods : Between March 2016 and March 2018, 17 EAUD with the Detour™ system were performed in 15 patients (2 bilateral), 13 women and 4 men (mean age 62 years, 40-87 years). 8 patients had complex ureteral stenosis caused by benign diseases or iatrogenic causes. 7 patients instead were affected by severe ureteral obstructions due to oncological pathologies. Among the 15 patients, 7 had a permanent nephrostomy tube. 10 patients had an indwelling DJ ureteric stent causing recurrent UTI and severe LUTS.


Results : The median follow-up was of 9 months (range 1-23). There were 3 explants (17% - Clavien IV): in 2 cases due to infection (1 KPC Klebsiella KPC pyelonephritis of the contralateral kidney; 1 due to an enteric fistula) and in 1 case due to the displacement of the distal end of the device. One patient developed a subcutaneous pelvic inflammatory collection after 1 month that was treated conservatively with complete resolution (Clavien II). 3 cases have an asymptomatic bacteriuria. 1 male patient have mild LUTS. No encrustation was observed during the follow up.


Conclusions : The Detour™ system can be considered an option for the treatment of complex ureteral stenosis of malignant, iatrogenic or benign etiology when other treatment options fail, not indicated or not tolerated.  Patients’ medical history is complex so they need to be accurately selected and prepared. Despite of this, complications are not negligible (risk of intestinal injury and infection).  Still though, the patients can benefit significantly in terms of QoL.

Michele Talso

Consultant Urologist
ASST Vimercate Hospital, Italy

Michele Talso
MD Urologist Consultant
ASST Vimercate Hospital MB
Italy

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    Elena Tondelli

    Urologist
    Vimercate Hospital

    My name is Elena Tondelli and I was born in Milan on 20/03/1983. I enrolled in the Faculty of Medicine and Surgery at the University of Milan in 2003: from the third year I began to attend Urology Department as an internal student, and I started to love every aspect of this discipline. In 2009 I graduated with the thesis titled "Testicular sperm extraction in patients with testicular tumor: new surgical method of storage of fertility” and after obtaining the professional qualification, I entered the Urology School of the University of Studies from Milan. During the specialization I studied in particular the andrological field at San Giuseppe Hospital in Milan and I acquired the technique of urological specialist ultrasound; I also completed training periods at General Surgery Departments, at a Pediatric Urology Unit and at the European Institute of Oncology. I specialized in urology in 2015 with 70/70 with the thesis titled "Use of sacral neuromodulator in the treatment of detrusorial iperactivity after prostatic radical surgery". After a short period of work at San Donato Milanese Hospital, from 2016 I work at the Hospital of Vimercate (MB) where I perform urological activity at 360 degrees but in particolar I dedicate myself to the endoscopic treatment of urinary calculosis and to the bladder and renal oncological pathology. At the same time I continue to perform the private andrological outpatient activity and I also collaborate in holding lectures at the faculty of medicine and the urology school.

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      Gianpaolo Zanetti

      Chief
      Vimercate Hospital

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        Ioannis Kartalas Goumas

        Head Endourology
        Vimercate Hospital

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          MP14-11 - Extranatomical Urinary Diversion with the Detour™ for the treatment of complex ureteric stenosis: preliminary experience with 17 cases.



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