title: Subcutaneous urinary diversion utilizing a nephrovesical stent: a superior alternative to long-term external drainage?
abstract: OBJECTIVE
  The use of external percutaneous nephrostomy drainage in patients with end-stage ureteral obstruction in whom ureteral stenting has failed presents significant compromises in the patient's quality of life. Toward this end, we present the initial experience in the United States with an intracorporeal nephrovesical stent.
  
  
  METHODS
  We performed successful subcutaneous urinary diversion in 2 patients with malignant, metastatic periureteral obstruction. Both patients had previously been managed with a chronic percutaneous nephrostomy that was both painful and inconvenient. The nephrovesical stent was inserted utilizing percutaneous access to both the kidney and bladder followed by creation of a subcutaneous tunnel between the two sites.
  
  
  RESULTS
  The nephrovesical stents are patent at 6 and 9 weeks postoperatively and both patients have had their nephrostomy tubes removed. Both patients have noted a marked improvement in their overall comfort and quality of life since the stent has been in place.
  
  
  CONCLUSIONS
  Subcutaneous urinary diversion with a nephrovesical stent provides effective urinary drainage and may improve the quality of life of patients with malignant metastatic ureteral obstruction. Further long-term studies are needed.
authors.affiliation: Department of Surgery, Washington University Medical Center, St. Louis, Missouri.
authors.forename: S Y
authors.initials: SY
authors.lastname: Nakada
authors.forename: A J
authors.initials: AJ
authors.lastname: Gerber
authors.forename: J S
authors.initials: JS
authors.lastname: Wolf
authors.forename: M E
authors.initials: ME
authors.lastname: Hicks
authors.forename: D
authors.initials: D
authors.lastname: Picus
authors.forename: R V
authors.initials: RV
authors.lastname: Clayman
mesh_terms: D000328:Adult; D000368:Aged; D004322:Drainage; D005260:Female; D006801:Humans; D015607:Stents; D013997:Time Factors; D014517:Ureteral Obstruction / Q000601:surgery*; D014547:Urinary Diversion / Q000295:instrumentation* / Q000379:methods