Nephroureterostomy as a treatment of obstructive uropathies: A single centre experience
Introduction:
It is very surprising that in U.K most of the hospitals and urology departements are not aware of nor they are practicing a very unique and simple technique of Nephroureterostomy, that can add extra time to the life expectancy of terminally ill patients of obstructive uropathy, especially patients with advanced prostate and pelvic cancers. Nephroureterostomy is simple to insert and easy to manage by the patients in community.We are providing “Percutaneous Nephroureterostomy” service for the past ten year. This is one procedure which seems to have been forgotten but it is considered as a safe and convienient alternative mainly as a palliative procedure for obstructing uropathies caused by an obstructing cancer.
Methods:
This project attempts to collect and create a baseline data to assess clinical effectiveness of the procedure by measuring outcomes. A retrospective data has been collected and analysed for 52 nephroureterostomy procedures that have been performed from Sept 2008 to Sept 2018, using various parameters. These include patient’s demographics, indications, length of stay in hospital, type of anaesthesia, technical difficulties of the procedure, complications and life expectancy of the patients following the procedure.
Results:
It was found that a total of 52 procedures including 13 bilateral were performed for 39 patients. Out of these, 32 (84%) of patients had advanced palliative cancer. 100% of procedures were performed as day cases using sedation. 74.3% of patients did not had any complication. 10 patients had complication related to the drainage tube. None of the patients had local or systemic infection.
Conclusion:
The data implies that Percutaneous Nephroureterostomy is a relatively safe procedure. Nephroureterostomy is a technique that combines the anatomical shape of JJ stent and an external nephrostomy. It can be inserted like ordinary nephrostomy under L.A or sedation but is advanced all the way to the bladder like an antegrade stent placement with external part of the tube still hanging out like ordinary nephrostomy tube. This avoids anesthesia for unfit patients and the need to avoid stents in patients where it is challenging surgically but at same time can avoid the management problems faced by patients in community. It can be used both as stents and in case where there is danger of its internal system blockage the external end can be uncapped and it works like nephrostomy thus avoiding unnecessary emergency admission of patients to hospital. It also escapes the problematic and unsighty look of nephrostomy bag and displacements that happen with their prolong use. Thus we strongly recommend to re introduce this technique in patients with permanent obstructive uropathy.
