Nephrovesical subcutaneous ureteric bypass: long-term results in patients with advanced metastatic disease-improvement of renal function and quality of life.
OBJECTIVE
Placing a percutaneous nephrostomy often is the only and final solution for patients with metastatic disease, where internal ureteral stenting proved to be impossible.


METHODS
Between August 1999 and June 2005, 31 nephrovesical ureteric bypasses were implanted in 28 patients with advanced metastatic disease. The ureteric bypass consists of two subcutaneously connected 12F polyurethane tubes, placed as a nephrostomy and cystostomy. Urinary culture, serum creatinine, quality of life score, and renal ultrasonography were evaluated at follow-up.


RESULTS
Mean follow-up was 11.9 mo (range, 2-54 mo). Preoperative hydronephrosis was eliminated in 27 cases (87.1%) and reduced in the remaining four kidneys (12.9%). Preoperative serum creatinine levels (5.9+/-3.2 mg%) decreased significantly postoperatively (1.4+/-0.9 mg%). Mean quality of life score was 3.4+/-1.4 preoperatively and 7.6+/-1.0 postoperatively. In five patients (17.9%) the system had to be replaced due to occlusion at a mean follow-up of 10.2 mo.


CONCLUSIONS
This nephrovesical ureteric bypass is a simple, minimally invasive, and highly effective treatment for patients with hydronephrosis resulting from advanced oncologic disease. Patients gain a better quality of life due to increased independence and mobility during their final stages of life.
Department of Urology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. joerg.schmidbauer@aon.at
Joerg
J
Schmidbauer
Christian
C
Kratzik
Hans Christoph
HC
Klingler
Mesut
M
Remzi
Jakob
J
Lackner
Michael
M
Marberger
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011184:Postoperative Period; D011788:Quality of Life; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014513:Ureter / Q000601:surgery*