Abstract
Long-term drainage of the urinary tracts of patients with impassable ureteric strictures remains a major challenge to the urologist. An ideal urinary diversion should provide symptomatic relief for the required duration without requiring multiple changes and should be associated with minimal or no morbidity.
Conventionally patients can be offered either a percutaneous nephrostomy or reconstructive surgery. Percutaneous nephrostomies compromise the quality of life and require an external bag in addition to regular changes. Unfortunately major reconstructive surgery is not ideal in most cases as the majority of the patients will have malignant disease associated with a poor prognosis and a median survival of 3 to 7 months (Kouba E, et al., J Urol 2008).
In all cases where there is a functional bladder that is free of active cancer, conversion to an internalised subcutaneous drainage system (extra anatomical stents (EAS)) should be considered.
For 16 years our department has treated patients with impassable ureteric strictures with either a short term EAS, which requires changing every 12 months, or a permanent form of EAS.
Techniques of insertion of both types of stents will be described and illustrated along with techniques for removal or change. In addition, our personal data of experience and outcomes over the past 16 years will be presented.