Subcutaneous urinary diversions for palliative treatment of pelvic malignancies.
OBJECTIVE
We developed 2 subcutaneous urinary diversion techniques, pyelovesical bypass and anterior cutaneous nephrostomy, to improve the quality of life of patients undergoing permanent palliative percutaneous nephrostomy.


METHODS
A total of 21 patients underwent either pyelovesical bypass (19) or anterior cutaneous nephrostomy (13). Technically, the percutaneous nephrostomy tube is replaced by a self-retaining expanded polytetrafluoroethylene-silicone tube tunneled underneath the skin. The distal extremity can be either introduced into the bladder, creating a pyelovesical bypass, or brought out directly through a cutaneous orifice, creating an anterior cutaneous nephrostomy.


RESULTS
No tube was dislodged and none became obstructed due to incrustation or angulation. Standard percutaneous nephrostomy was necessary in 1 patient in each group. Improvement in the quality of life was stressed by all patients. Pyelovesical bypass eliminates external drainage and anterior cutaneous nephrostomy performed when the bladder is no longer functional allows for the creation of a single, easily dressed anterior stoma.


CONCLUSIONS
Pyelovesical bypass and anterior cutaneous nephrostomy constitute valuable alternatives to standard permanent palliative percutaneous nephrostomy.
Desgrandchamps
F
F
Department of Urology, Saint-Louis Hospital, Paris, France.
Cussenot
O
O
Meria
P
P
Cortesse
A
A
Teillac
P
P
Le Duc
A
A
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation / Q000379:methods*; D010166:Palliative Care; D010386:Pelvic Neoplasms / Q000150:complications / Q000601:surgery*; D014570:Urologic Diseases / Q000601:surgery*