Detour – An Alternative to Chronic Nephrostomy

lek. Michał Piotrowski

Skamex Sp. z o.o.

What is Detour?

Detour is an artificial ureter used when no other solution is possible, and the patient must have a nephrostomy, which means living with a "hole in the back" where a catheter is placed. This catheter can become a gateway for infection, potentially leading to kidney loss. Living with a nephrostomy – a catheter in the back – imposes many limitations on daily life. Patients are unable to engage in previous activities such as swimming, running, or driving a car. Even daily tasks like bathing and sleeping become significantly more challenging.

A nephrostomy can also limit career development opportunities, as patients may struggle with performing certain tasks. Additionally, the patient must visit a doctor approximately every three months to have the nephrostomy replaced.

If you or someone you know has a nephrostomy, there is a solution that allows for a return to an active life. After the implantation of the Detour artificial ureter, the patient can once again go swimming, sleep normally on their back, drive a car, and work. The nephrostomy, meaning the catheter protruding from the back, is no longer necessary – the Detour artificial ureter is hidden under the skin.

Detour Artificial Ureter

Sztuczny moczowód Detour, Detour – czyli alternatywa dla przewlekłej nefrostomii,  nefrostomia

Detour Kit

The solution is Detour – an artificial ureter. The Detour Kit includes an artificial ureter, a tunneler, and an Amplatz sheath. The artificial ureter is a silicone tube with a length of 840 mm and an internal lumen of 17Fr/CH (5.8 mm), surrounded by a polyester sheath along 660 mm of its length. It has an X-ray ring at the renal end to facilitate localization in the kidney during implantation.

Indications for the procedure

Detour, or the artificial ureter, is typically implanted for various reasons, most commonly:

  • Obstruction of the ureters in the course of oncological diseases (gynecological diseases, colorectal cancer, radiotherapy).
  • Obstruction of the ureters in the course of Ormond's disease.
  • Necrosis of the ureters in a transplanted kidney.
  • Absence or injury of the ureter.

Preparation for the procedure

The patient should perform a urine culture from the nephrostomy about 10 days before the procedure (if the patient has a nephrostomy). Then, at least 3 days before the procedure, the patient should start taking a targeted antibiotic if the culture is positive or a broad-spectrum antibiotic if the culture is sterile.

Course of the procedure

The procedure is usually performed under general anesthesia, with the patient positioned to allow access to the kidney and urinary bladder. The first part of the procedure involves accessing the renal pelvis and placing the Detour stent at the border of the renal parenchyma and calyx, with the renal end positioned so that the X-ray ring is visible at the border of the calyx and parenchyma. This placement ensures that the calyx contains silicone, while the parenchyma contains the polyester sleeve of the artificial ureter. Next, the surgeons make a suprapubic incision and isolate the urinary bladder, which is filled by a Foley catheter at this stage to facilitate the localization of the bladder.

The bladder is secured with two sutures, known as "bridles." Next, a tunnel is created in the adipose tissue using a special tool included in the artificial ureter set. The Detour stent is then passed through this tunnel, fitted, shortened, and subsequently sewn into the bladder.

After the procedure

The patient receives antibiotic therapy for a minimum of 10 days, and the Foley catheter is maintained during this period.

Patients should massage the artificial ureter at least 3-4 times a week to prevent encrustation; the manufacturer recommends doing this once a day. The patient should gently massage along the path of the artificial ureter under the skin with their fingers. The artificial ureter is easily palpable under the skin.

The average duration of the procedure is approximately 2 hours, and the average hospitalization time is 5 days.

Most common adverse symptoms

  • For a period of 2-3 weeks after the procedure, postoperative pain may occur. In the later period, patients typically do not feel the artificial ureter.
  • The Detour artificial ureter is intended to last for a lifetime, though in exceptional situations it may require replacement.
  • Leakage and seepage from the bladder side can occur, most commonly due to the Foley catheter being maintained for too short a period after the procedure.
  • The Detour, like any foreign body implanted into the human body, can become infected. Therefore, all aseptic and antiseptic principles must be strictly followed before and during the procedure.
  • If the patient has a nephrostomy and no alternative is available, they should ask their doctor about the artificial ureter, also known as the Detour.
  • The first procedure was performed in May 2013 at the PSK2 Hospital in Szczecin on a palliative care patient, and the second in September 2013 at the District Hospital in Mielec.
  • The patient operated on in Mielec is still alive today, with a functioning ureter for the past 4 years.
  • Since 2013, nearly 40 procedures have been performed in Poland*.
  • There is already over 14 years of experience worldwide with the Coloplast Porges artificial ureter.

Recommended centers for Detour implantation

Detour set – procedure

The procedure is usually performed under general anesthesia, and patients must have a functional bladder; it cannot be a shrunken bladder. In Europe, the Detour has also been implanted in cases of intestinal bladders.

In 2016, a film was made for patients about living with a nephrostomy and how their lives changed after the implantation of an artificial ureter. The film features real patients from across Europe who share their stories. We managed to include 3 patients from Poland in the film. The film will be available in 2017.

In 2017, Dr. Andrzej Wrona, the head of the Department of Urology and Oncological Urology at the District Hospital in Mielec, was invited to a conference in Milan. There, he shared his experiences with implanting the artificial ureter during his lecture for Italian urologists.

Dr. Andrzej Wrona has the most extensive experience in Poland, having implanted artificial ureters in over 25 patients.

*as of July 2017

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