[Prospective study of the quality of life after palliative urinary diversion by subcutaneous pyelovesical bypass (Detour ureteric prosthesis)].

OBJECTIVE

To prospectively evaluate the quality of life of cancer patients at the palliative stage after implantation of an extra-anatomical ureteric prosthesis as an alternative to permanent percutaneous nephrostomy (PCN).

MATERIAL AND

METHODS

A series of 27 prostheses in 19 patients with PCN was prospectively evaluated. The ureteric prosthesis (Detour) consists of two concentric tubes glued to each other. The inner tube is made of silicone and the outer tube is made of polyester. This prosthesis is introduced percutaneously into the renal pelvis as an alternative to nephrostomy. It is tunnelled subcutaneously and is introduced into the bladder via a short incision. Patients were reviewed every three months for 18 months or until death. The EORTC QLQ-C30 self-administered questionnaire was used to evaluate the patients' quality of life. The functioning and position of the prostheses were verified by ultrasound and/or intravenous urography (IVU).

RESULTS

There were no failures of prosthesis placement and no intraoperative or early postoperative complications. Injection of the suprapubic incision was observed in 3 cases, in patients with pre-existing bladder disease (radiation cystitis or bladder tumour). The mean follow-up was 7.8 months: 6.6 months for the group of patients who died (15) and 12 months for the 4 patients still alive at the end of the study. Functional scores improved due to elimination of the external nephrostomy tube. In parallel, physical score deteriorated due to disease progression. Overall quality of life and index of satisfaction were improved by elimination of the external diversion.

CONCLUSION

Subcutaneous pyelovesical diversion ensures a better quality of life than classical percutaneous nephrostomy in cancer patients at the palliative stage.