Podkozhnoe obkhodnoe nefrovezikal'noe shuntirovanie pri obstruktsii mochetochnikov

We performed subcutaneous bypass draining (SBD) of the upper urinary tract (UUT) in 12 patients (3 males, 9 females, mean age 64 years) in 2006-2008. Ureteral obstruction was caused by a tumor in 11 patients, one patient had extended obliteration of the left ureter after resection of the abdominal aorta aneurysm and two plastic operations on the UUT. All the patients with ureteral tumor obstruction had only one functional kidney. For SBD of the kidney we used Detoure stent in 2 cases, the nephrovesical bypass - in the rest cases. Surgery was made in the lateroposition of the patient which provided sumaltenous establishment of the renal and vesical ends of the stent. The kidney was also drained by the nephrostoma in 8 patients. The nephrostoma was removed after antegrade pyelography and pyelomanometry. Intraoperative complications were not registered. Suprapubic urine leak in 3 patients previously given radiotherapy was stopped by a long drain of the bladder. Obstruction of the distal stent part by a progressive tumor was diagnosed in 1 patient 3 months later. The bypass was removed and a nephrostomic drainage was made. The nephrovesical stent was changed in one case 5 months after SBD. Upon 6-32 month follow-up 3 patients died of cancer progression, the rest are still alive. Thus, SBD is indicated if stenting, ureteral endoprosthesis, constant nephrostomic drainage are impossible. In some cancer patients with ureteral obstruction in UUT drainage SBD is a method of choice with promising short- and long-term results.

мочеточник, обструкция, нефровезикальное шунтирование