title: Pyelovesical bypass graft for palliative management of malignant ureteric obstruction: optimizing the technique by percutaneous access to the bladder using a split Amplatz sheath.
abstract: OBJECTIVE
  To introduce a simple modification to the original technique of pyelovesical bypass graft placement to make the procedure more minimally invasive.
  
  
  METHODS
  During the study period 2 patients with malignant ureteric obstruction underwent pyelovesical bypass graft placement using Detour stent (Mentor-Porges). The technique simply comprised tract dilatation of the previously placed percutaneous nephrostomy to place the proximal end of the graft in the renal collecting system, making a subcutaneous tunnel from a 1-cm suprapubic incision to the flank area, percutaneous access to the bladder under fluoroscopic guide and placement of the distal end of the stent into the bladder through a split Amplatz sheath. The operative outcome was analyzed prospectively.
  
  
  RESULTS
  Both patients tolerated the procedures well with no intra- and postoperative complications. Renal function remained stable during the follow-up period with acceptable urine output through the urethra. Abdominal wall complications such as fistula formation or pain along the subcutaneous tract as well as stent encrustation did not occur during the follow-up period.
  
  
  CONCLUSIONS
  Despite our small sample size and short follow-up period, percutaneous access to the bladder using a split Amplatz sheath during placement of the Detour stent, may be considered as a promising simple modification to optimize the technique by obviating the need for open cystostomy incision.
authors.affiliation: Department of Urology, Shiraz Nephrology Urology Research Center and Comparative Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. aminsharifi_ar@yahoo.com
authors.forename: Alireza
authors.initials: A
authors.lastname: Aminsharifi
authors.forename: Alireza
authors.initials: A
authors.lastname: Taddayun
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Jafari
authors.forename: Ehsan
authors.initials: E
authors.lastname: Ghanbarifard
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000150:complications; D003536:Cystadenocarcinoma / Q000150:complications; D053715:Cystotomy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D009361:Neoplasm Invasiveness; D009403:Nephrostomy, Percutaneous; D010051:Ovarian Neoplasms / Q000150:complications; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000150:complications