MP41-02 CAN EXTRA ANATOMICAL URINARY DIVERSION (EAUD) BE USED SAFELY IN ELDERLY CANCER PATIENTS?

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (MP41)1 Apr 2020MP41-02 CAN EXTRA ANATOMICAL URINARY DIVERSION (EAUD) BE USED SAFELY IN ELDERLY CANCER PATIENTS? Ioannis Goumas*, Sune Jeppesen, Torben Pedersen, Mikhail Diatchikhine, Marcin Popiolek, Andrzej Wrona, and Lars Lund Ioannis Goumas*Ioannis Goumas* More articles by this author , Sune JeppesenSune Jeppesen More articles by this author , Torben PedersenTorben Pedersen More articles by this author , Mikhail DiatchikhineMikhail Diatchikhine More articles by this author , Marcin PopiolekMarcin Popiolek More articles by this author , Andrzej WronaAndrzej Wrona More articles by this author , and Lars LundLars Lund More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000890.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Treatment of complex ureteral stenosis or lesions can be challenging. Ureteral bypass connects directly the renal cavities to the bladder with a specially designed subcutaneous tube. The main indication is in patients with a ureteral obstruction related to malignancy. It can be relieved by nephrostomy or tumor stent but it often causes problems with quality of life. We want to investigate whether EAUD will be safe in elderly cancer patients and improve quality of life. METHODS: The trial was a prospective cohort study performed at four sites with 60 patients between 2016 and 2018. The EAUD is a Detour™ nephro-vesical subcutaneous bypass with a 30 Fr tube made of 2 components: an outer reinforced PTFE sheath with porous structure and a silicone inner sheath. The patient is in a supine position with a percutaneous nephrostomy. We proceed with a dilatation of the percutaneous access using fascial dilators or a balloon, and a 30 Fr Amplatz sheath is inserted. If the nephrostomy is not in an adequate position, an ultrasound guided percutaneous access is performed through an adequate calyx with a direct access to the renal pelvis. Dilatation then proceeds as described above. The Detour™ proximal end is positioned into the renal cavities through the Amplatz sheath. The bladder is then isolated through a minilaparotomy. A subcutaneous tract between the bladder and the percutaneous access is created with a tunneler and the Detour™ in passed through the tract in order to reach the bladder. A 1 cm cystotomy is performed on the bladder dome. The Detour™ distal end is then tailored to the proper length and it is anastomosed to the bladder. A bladder catheter is left in place for 5 days. RESULTS: Indication for EAUD was a malignant diagnosis in 36 cases (60%). There were 11 (31%) elder than 70 years of age (mean age 76 years (SD 5.55) and 25 (69%) younger than 70 years of age (mean 53 years (SD 10.06). Median operative time was 94.36 minutes ± 30.37 minutes for the malignant cases and 81.02 minutes ± 31.63 for the benign cases (P> 0.17). There were no intraoperative complications or significant difference in complications in the elderly (> 70 years of age) compared with younger patients (P>.39). There were no significant differences in hospital stay (days), (malign/benign) (12.50 days ± 7.11/ 21.00 days ± 28.56) (P=0.07). No mortality in the first 90 days. In 4 cases an explant was performed: 1 due to displacement of the bypass distal end, 1 due to a multidrug-resistant infection and in 2 cases due to an enteric fistula. CONCLUSIONS: EAUD is a clinically safe and promising treatment for elderly patients with complex ureteral stenosis due to cancer. EAUD reduces the number of nephrostomies and changes of JJ stents and thereby improving the quality of life and reduces the costs. However, the procedure is complex due to high comorbidity patients with previous radiation or surgery and the high risk of infection. Patients must be appropriately informed about these risks. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e595-e596 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ioannis Goumas* More articles by this author Sune Jeppesen More articles by this author Torben Pedersen More articles by this author Mikhail Diatchikhine More articles by this author Marcin Popiolek More articles by this author Andrzej Wrona More articles by this author Lars Lund More articles by this author Expand All Advertisement PDF downloadLoading ...