Extra-anatomical urinary diversion for malignant ureteric obstruction: our clinical experience

Introduction and Objectives: Ureteral stenosis and upper urinary tract obstruction present significant clinical challenges, especially in cases involving complex, long strictures. Traditional management options like ureteral stents and percutaneous nephrostomy tubes often result in complications and diminished quality of life. Extra-anatomical urinary diversion (EAUD) offers an alternative approach, particularly for oncologic patients requiring palliative care. Materials and Methods: From 2015 to 2019, eight patients with cancer-related ureteral strictures underwent EAUD. In all patients cancer-specific prognosis exceeded one year. The procedure was performed using a standard surgical technique. Results: The mean patient age was 62.5 years, ranging from 22 to 82 years. The mean follow-up duration was 62.8 months. Improvement in renal function was observed in some patients, while the early complication rate was 62.5%. Notable complications included infections and encrustation of the prosthesis. Two patients experienced multiple infections of the overlying skin and soft tissue necessitated the dislodgement of the prothesis after 38 and 101 months, respectively. Conclusions: Extra-anatomical stent placement constitutes a somewhat effective and safe option in the context of complex ureteral obstruction management in oncologic patients. The lack of external devices and its longer duration without the need for substitution compared with conventional double J stents can theoretically assure a better quality of life. However, a careful patient selection is needed in order to maximize the patients' benefit.