title: The detour extra-anatomic stent--a permanent solution for benign and malignant ureteric obstruction?
abstract: OBJECTIVE
  We describe our experience of the Detour extra-anatomic stent (EAS) (Mentor-Porgés, UK) for permanent bypass of complete upper urinary tract obstruction. The self-retaining expanded polytetrafluoroethylene-silicone tube, placed in the kidney using a percutaneous route, is tunnelled under the skin and sutured into the bladder to establish extra-anatomical urinary drainage.
  
  
  METHODS
  From April 2002 to November 2005, a total of nine Detour stents were inserted into eight patients; one patient needed bilateral stent insertions. The causes for ureteric obstruction were persistent malignant disease in three and complicated benign disease in five patients.
  
  
  RESULTS
  To date, four of five patients with benign disease are alive; one died unexpectedly of metastatic malignancy. The only stent-related complications were infection and haematuria. The two patients with malignancy have subsequently died, but there were no urinary drainage problems for their second and third years of life, respectively.
  
  
  CONCLUSIONS
  The preliminary data presented here suggest that the Detour EAS offers a permanent and minimally invasive method to establish internalisation of urinary drainage to bypass complete ureteric obstructions for which conventional stenting has failed, open surgery has been tried and failed or was not considered feasible, and long-term nephrostomy drainage was not favoured.
authors.affiliation: Department of Urology, St James's University Hospital, Leeds, England, UK. slloyd140@btinternet.com
authors.forename: Stuart N
authors.initials: SN
authors.lastname: Lloyd
authors.forename: Prasanda
authors.initials: P
authors.lastname: Tirukonda
authors.forename: Chandra Shekhar
authors.initials: CS
authors.lastname: Biyani
authors.forename: Tze M
authors.initials: TM
authors.lastname: Wah
authors.forename: Henry C
authors.initials: HC
authors.lastname: Irving
mesh_terms: D000328:Adult; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001672:Biocompatible Materials; D002295:Carcinoma, Transitional Cell / Q000150:complications; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011471:Prostatic Neoplasms / Q000150:complications*; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012186:Retroperitoneal Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D012509:Sarcoma / Q000150:complications; D012828:Silicones; D015607:Stents; D014513:Ureter / Q000293:injuries; D014516:Ureteral Neoplasms / Q000150:complications*; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D014567:Urography; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D001672:Biocompatible Materials; D012828:Silicones; C050905:polytetrafluoroethylene-silicone; D011138:Polytetrafluoroethylene