Morbidité et résultats à long terme du pontage pyélo-vésical sous-cutané dans l’obstruction urétérale chronique

16 mai 2021

Auteurs : A. Nouaille, A. Descazeaud, F. Desgrandchamps, D. Bazin, M. Daudon, A. Masson Lecomte, P. Mongiat-Artus, P. Meria
Référence : Prog Urol, 2021, 6, 31, 348-356




 




Abbreviations


PTFE : polytetrafluoroethylene
SPIR : infrared spectrophotometry
SEM : scanning electron microscopy


Introduction


Chronic ureteral obstruction can be due to various conditions, either benign or malignant. The management of ureteral obstruction can be challenging, particularly for certain diseases.


Endoscopic techniques and devices have evolved, and current management of such strictures can be achieved most frequently with minimally invasive procedures.


Ureteral stenting remains the first choice, however the placement of JJ stents is not always possible due to the tightness of the stricture [1]. Likewise, JJ stents encrustation require their replacement on a regular basis [2, 3].


Metallic stents represent an alternative to JJ stents but they are associated with specific problems such as migration or urothelial hyperplasia [2, 4].


In case of endoscopic treatment failure, surgical techniques can be proposed, but their use is limited to patients with a long life expectancy [5].


Permanent percutaneous nephrostomy remains the most frequent choice after ureteral stent failure, but patients quality of life can be significantly impaired [6, 7].


For these reasons, we have developed a subcutaneous pyelovesical bypass consisting in an extra-anatomic ureteral replacement by the means of an original prosthesis (DETOUR®, Porgès, Coloplast).


Initially, this prosthesis was intended for patients with malignant ureteral obstruction, most of them being in palliative care [8]. Subsequently we extended the indications of DETOUR® prosthesis to selected cases with nonmalignant ureteral obstructions.


The aim of this study was to evaluate the long-term results, complications of the DETOUR® prosthesis and risk factors for prosthesis failure.


Materials and methods


Prosthesis characteristics


The DETOUR® prosthesis consists of two coaxial tubes—an inner tube of silicone, known to be waterproof and resistant to encrustation, and an outer tube of expanded polytetrafluoroethylene (PTFE), which is an inert material limiting inflammatory reactions (Figure 1, Figure 2). The woven and porous structure of PTFE enhances the adhesion of the surrounding tissues to the prosthesis, ensuring its anchorage and reducing the risk of peri-prosthetic infection by encapsulation. This outer layer is reinforced by a spiral structure in radiopaque plastic that solidifies the prosthesis and facilitates its self-fixation in the tissues. A radio-opaque ring marks the junction between the inner silicone and outer PTFE layer proximally and facilitates accurate placement of the proximal end of the stent within the kidney. The prosthesis displays high internal and external diameters (5.8mm and 9mm, respectively), limiting the risk of obstruction by incrustation or kinking.


Figure 1
Figure 1. 

Subcutaneous pyelovesical derivation by DETOUR® prosthesis. (Extract of: Savoie P-H, Laroche J, Vallier C, Fournier R. Réparations chirurgicales des lésions de l’uretère. EMC - Technique Chirurgicale - Urol 2013611-15 Artic 41-125. 2013 Jan 11; Copyright © 2013 Elsevier Masson SAS. Tous droits réservés.).




Figure 2
Figure 2. 

DETOUR® Prosthesis—Description.




Surgical technique


The procedure is performed under general anesthesia. As for a supine percutaneous nephrolithotomy, the patient is positioned in the lateral decubitus position at 30-45° in order to access to the lumbar fossa and the suprapubic region. After the puncture of the lower renal calyx using ultrasound and radioscopic guidance, a guide wire is placed and the dilation of the tract is performed in order to place an Amplatz 30 Fr sheath, required for the prosthesis insertion. The proximal end of the prosthesis is introduced within the kidney through the sheath, taking care of placing the radio-opaque ring at the tip of the calix. The external spiral allows anchorage without additional fixation to the renal parenchyma and the subcutaneous tissue. The subcutaneous tract from the lumbar fossa to the supra-pubic region is performed with a special tunneler, and a short incision is made in order to extract the prosthesis ahead of the bladder. The bladder, previously filled with physiological saline, is opened. After removal of the outer PTFE layer, the distal part of the prosthesis is inserted within the bladder and fixed to the detrusor using absorbable sutures. A urethral catheter is placed for 7 days.


Patients


Between 2006 and 2018, 28 patients with chronic ureteric obstruction were treated with a DETOUR® prosthesis. All of them had been previously treated with double-J ureteral stent and/or a percutaneous nephrostomy for an average of 14 months before the DETOUR® bypass. None of them had functional or neurologic bladder disorders. Patients characteristics and etiologies of ureteric obstruction are summarized in Table 1. Five patients with a non-malignant obstructive etiology had a contraindication for surgical repair like ureteroileoplasty. We retrospectively reviewed short- and long-term complications. Patients follow up began at DETOUR® prosthesis placement and ended at death, prosthesis removal or end of the study.


Statistical analysis


Analysis of risk factors for DETOUR® prostheses failure was performed using a Student's t-test or a Kendall correlation test. The search for a specific association between bladder fistula and radiotherapy was evaluated by a logistic regression. The assessment of the DETOUR®â€™s lifespan was done with a Kaplan—Meier analysis.


Additional analysis


In order to explore the causes of DETOUR® prostheses encrustation, complementary infrared spectrophotometry and scanning electron microscopy were performed on two removed prostheses for obstruction or infection. An unused prosthesis served as a control.


The primary study outcome was prostheses complications. The secondary outcome was protheses lifespan. This is the time between the implantation and the prothesis removal, the patient death, or the end of the study.


Results


Over the study period, 34 implantations were performed in 28 patients (12 women (43%) and 16 men (57%)); 6 were bilateral, 6 were on the right, 15 were on the left and 1 was implanted in a transplanted kidney (Table 1). The mean age of the patients was 65.8±13.3 years, and the average duration of follow-up was 25.8±19.4 months.


Early complications (<30 days)


There were no intraoperative complications. The post-operative complications are summarized in Table 2 according to Clavien Dindo's classification [9].


A patient with metastatic colon cancer, in palliative care, died postoperatively. Three patients developed an early bladder fistula after the ablation of the urinary catheter, requiring another intervention to perform a new vesico-prosthetic anastomosis. Two of these patients did not develop another bladder fistula.


Delayed complications (>30 days)


The late complications are summarized in Table 3. The main complication was infection (46%), ranging from cystitis to severe sepsis. The three cases of severe sepsis occurred at a mean of 38 months (±29,9 months) after the prostheses implantation.


Bladder fistula occurred in 25% of the patients. A second operation for the creation of a new vesico-prosthetic anastomosis was necessary for two patients (Clavien IIIb). Prosthesis occlusion occurred in three patients at a mean of 45.3 months (±19 months) after the surgical implantation. Two of them had a history of urinary stones, and the third had recurrent urinary tract infections. Each of them had kidney function impairment estimated from 10% to 30% at renal scintigraphy before the prostheses implantation.


Prostheses lifespan


The average lifespan of the prostheses was 25.8 months (range, 0 to 64 months; standard deviation,±19.4 months). Ten prostheses, in 9 patients (32%) required surgical removal. The surgical indications for removal are summarized in Table 4.


Two cases of delayed death were observed at 4 months and 4.2 years after the implantation. Both related to severe Candida albicans sepsis, despite optimal antifongic therapy and surgical prostheses removal.


During the study period, 14 patients died of cancer and one patient died from cardiac disease. In 13 of these patients, the prosthesis was functional at the time of death. For the two others, percutaneous nephrostomy was necessary at 24 and 53 months due to tumor progression (colovesical fistula and bladder tumor). At the end of the study, with a mean follow up of 34.8 months (range, 12 to 56 months), 4 patients were still alive with a functional prosthesis without major complications.


Statistical analysis


The risk factors for prostheses failure is summarized in Table 5.


We observed a trend towards higher rate of bladder fistula in patients previously treated with radiotherapy with a OR of 5.33 [CI 95%(0.91–32,32), P =0,05]. The Kaplan–Meier analysis (Figure 3) showed functional prosthesis rate at 1 year, 2 years, 3 years, 4 years, and 5 years, respectively, of 94%, 71%, 62%, 54% and 34%.


Figure 3
Figure 3. 

Durability of the DETOUR® prosthesis according to Kaplan–Meier analysis.




Infrared spectrophotometry (SPIR) and scanning electron microscopy (SEM)


The spectrophotometric analysis of the prosthesis calcifications detected a high level of carbapatite (calcium carbonate orthophosphate), whewellite (calcium oxalate monohydrate) and proteins. Phosphocalcic encrustations and the high carbonation rate of calcium phosphates were related to infection.


The SEM analysis was performed on cross-sections of the two removed prostheses.


Within both prostheses, apatite deposits were present (Figure 4). The prosthesis removed for obstruction was marked by a large encrustation (Figure 5) and an altered silicone wall (Figure 5). Within these calcifications, bacterial prints have been observed (Figs. 6 and 7).


Figure 4
Figure 4. 

Prosthesis 1. Internal surface of the silicone layer, smooth with adherent apatite-like deposits. Scale 10μm.




Figure 5
Figure 5. 

Prosthesis 2. Important calcifications embedded in the inner wall of the silicone, eroding its surface. Scale 100μm.




Figs. 6 and 7
Figs. 6 and 7. 

Prosthesis 2. Intra-prosthetic calcifications with bacterial impression. Scales 200μm (Fig. 6) and 10μm (Fig. 7).





Discussion


The implantation of the DETOUR® subcutaneous extra-anatomic bypass was shown to be an effective technique for urinary diversion, initially in palliative care for patients with end stage cancer [8, 10]. The indications were subsequently extended to patients with non-tumoral ureteric obstructions of various etiologies.


In selected patients, particularly those where malignant obstruction has proven resistant to complex reconstruction or repeat stenting, the opportunity to internalise nephrostomy drainage can significantly improve quality of life.


The follow up of our study is above that of other studies since the maximum follow up was 64 months.


The major complications were infection, obstruction and bladder fistula. Our complication rate were comparable that of other authors [11, 12, 13, 14, 15].


The rate of infectious complications was 46%, mostly non-severe (77% of cases Clavien II) and treated with appropriate antibiotic therapy. Janitzky [12], in a series of 40 prostheses implantations in 31 patients with an average follow-up of 23 months, reported an infection rate similar to that observed in our series [12]. He concluded by recommending a nephrostomy change 48hours before prosthesis implantation to minimize the risk of infection in patients with preexisting nephrostomy. In such patients, our preventive strategy consists in preferring a new renal puncture for prosthesis placement, instead of reusing the preexisting nephrostomy tract. In all cases the procedure requires antibiotic prophylaxis.


The incidence of late bladder fistula was observed in 25% of our patients and required prolonged bladder catheterization. The incidence of this complication was reported by others in 3% to 25% of the cases [12, 14, 16, 17]. Our data showed a trend towards increased risk of bladder fistula in patients previously treated with pelvic radiotherapy (OR 5.33 [CI 95%: 0.91; 32,32] P =0,05). The absence of statistical significance is probably due to the small number of patients given that pelvic radiation therapy was demonstrated as a risk factor for bladder fistula [18].


Three (10.7%) prostheses were removed for obstruction within an average of 45 months. Two patients had a history of urinary stone disease and all displayed an alteration of the diverted kidney's functional value. A similar obstruction rate, ranging from 7% to 25%, was described by others [10, 12, 13, 14, 15]. Obstruction was successfully managed with flexible ureteroscopy [10, 15, 19], prosthesis replacement [12] or litholytic treatment (alkalinisation of the urine in the cases of obstruction by uric acid stones) [20].


Encrustation require a frequent change of JJ stents and nephrostomy. The large diameter of the prothesis increase this risk of obstruction.


Although most infectious complications were non-severe, the prostheses had to be explanted in 4 of our patients due to infectious complications (severe sepsis, candidemia and recurrent infections).


Two cases of Candida albicans infection were observed resulting in patients’ deaths despite prostheses removal and optimal medical treatment. This complication has been reported, by Muller and al. [11], in a patient with a kidney transplant 1.5 years after the procedure. Other authors reported that recurrent fungal infections of the prostheses led to their obstruction by fungal balls [21, 22]. The obstruction can be managed by the placement of transient nephrostomy [21] or by endoscopic fungal balls treatment [22]. Our data suggest that fungal infection require early prostheses replacement or ablation. Such attitude was also proposed by others [11, 23]. Such attitude can be proposed in case of severe sepsis with failure of antibiotic therapy.


Infrared spectroscopy and scanning electron microscopy gave us an overview of the mechanisms leading to prostheses encrustation and obstruction. As demonstrated by others, our analyses suggest that infectious mechanisms of lithogenesis occurring in an alkaline medium were responsible for the encrustations and obstructions [24, 25, 26]. Obstruction and encrustation being favored by an alkaline medium, acidification of the urine might represent an effective method to prevent lithogenesis [27]. However, acidification increases the risk of candiduria, and the risk-to-benefit ratio must be evaluated. Considering the small number of explanted prostheses available for analysis, these conclusions should be interpreted with caution and further studies have to evaluate theses preventive measures.


The purpose of the DETOUR® prosthesis is to avoid permanent percutaneous nephrostomy. Therefore, studies included a limited number of patients, heterogenous, and most of them had a short life expectancy. For a better evaluation of the prosthesis's lifespan with this limitation, a Kaplan Meier analysis was performed. At 1 and 2 years, the functional prosthesis rate was 94% and 71%, respectively. After 4 years, this rate was about 50%. Thus, as initially proposed, the DETOUR® pyelovesical prosthesis is preferentially intended for patients with a short life expectancy, including end-stage malignant diseases.


Nevertheless, the DETOUR® prosthesis could be proposed in other limited indications, such as ureteral stenosis in transplanted kidney, when ureteral reconstruction procedure has failed or thought to be too hazardous. In our patient with a kidney transplant, the prosthesis remained functional without major complications for 39 months. Other authors have demonstrate that pyelovesical derivation can be a safe and efficient alternative to open surgery in such patients [11, 28, 29, 30].


The patients’ quality of life was not evaluated in our work. However, Janitzky (12) and Desgrandchamps [17] have reported a significant improvement in the quality of life of their patients after DETOUR® implantation. Their results are encouraging and seem to demonstrate that the complications observed in our series are partially counterbalanced by the significant improvement of patients’ quality of life, particularly in those with preexisting nephrostomy.


The gold standard for malignant ureteral obstruction remains the JJ stents. Given the frequent infectious complications of the prosthesis, it is not a good alternative to the JJ stent in current practice. Nonetheless, the large diameter of the Detour® prothesis reduces the risk of incrustation, which is the main cause of obstruction and change of JJ stents, nephrostomy, and ureteral stents. It's for this reason the Detour is a good alternative of permanent percutaneous nephrostomy.


A comparative study between percutaneous nephrostomy and Detour® prosthesis would be necessary to confirm the benefit of the prosthesis.


Another limitation of the study is that it is retrospective. Due to missing data, the impact of the prosthesis on renal function could not be assessed.


Conclusion


The DETOUR® subcutaneous extra-anatomical urinary bypass is an effective and minimally invasive alternative to the permanent percutaneous nephrostomy, without periodic prostheses changes and free from external devices. The risk of complications of the pyelovesical derivation requires careful patient selection with malignant and benign ureteral obstructions.


The primary indication for the prosthesis is for malignant ureteric obstruction by offering patients to increased independence, flexibility, and mobility during their final period of life.


Disclosure of interest


P. Meria is consultant for Porges–Coloplast.


The other authors declare that they have no competing interest.


Research involving Human Participants and/or Animals


The following manuscript is a review of existing data. Therefore, this article does not contain any studies with human participants or animals performed by any of the authors.


Informed consent


For this type of study (retrospective review) formal consent is not required.




Table 1 - Characteristics of patients, etiologies of obstruction, and complementary treatments.
Patient features 
Average age  65.8 years (range, 24 to 91 years) 
Gender   
Female  12 (43%) 
Male  16 (57%) 
Etiology of obstruction   
Malignant  23 
Tumor compression  10 
Primitive tumor 
Peritoneal carcinomatosis 
Retroperitoneal lymphadenopathy 
Post radiotherapy 
Surgical lesion (surgical oncology) 
Benign 
Ureteral injury after ureteroscopy 
Pyeloureteral obstruction after renal transplantation 
Failure of uretero-ileoplasty for idiopathic ureteric stenosis 
Ureteral obstruction after ureterolysis for retroperitoneal fibrosis 
Prior chemotherapy  13 (46.4%) 
Prior pelvic radiotherapy  8 (28.6%) 





Table 2 - Early complications according to the classification of Clavien Dindo (< 30 days).
Clavien-Dindo Classification  Early complications (<30 days)  n (%) 
Clavien II  Bladder fistula treated by reinsertion of the urinary catheter  4 (14.3%) 
  Lumbar cellulitis treated with antibiotic therapy  1 (3,6%) 
  Macroscopic hematuria  1 (3.6%) 
  Prostatitis  1 (3.6%) 
  Subcutaneous hematoma  1 (3.6%) 
  Acute renal failure (by clotting in the renal cavities and manage by hyperhydration)  1 (3.6%) 
Clavien IIIb  Re-intervention for a new vesico-prosthetic anastomosis for:  3 (10.7%) 
  Retraction of the internal silicone tube  1 (3.6%) 
  Bladder fistula  1 (3.6%) 
  Bladder disinsertion  1 (3.6%) 
Clavien V  Death due to care cessation  1 (3.6%) 





Table 3 - Late minor and major complications.
Late complications (>30 days)  n (%) 
Minor complications   
Cystitis  4 (14.3%) 
Delay of wound healing  1 (3.6%) 
Macroscopic hematuria  4 (14.3%) 
Irritative symptoms  5 (17.8%) 
Major complications   
Infection  9 (32%) 
Suprapubic abscess  5 (17,8%) 
Non-complicated acute pyelonephritis  5 (17,8%) 
Severe acute pyelonephritis with sepsis  3 (10,7%) 
Candidaemia  2 (7,1%) 
Macroscopic hematuria  2 (7.1%) 
With transfusion (irradiated bladder)  1 (3.6%) 
Without transfusion  1 (3.6%) 
Delay of suprapubic wound healing  1 (3.6%) 
Bladder disinsertion of the prosthesis  1 (3.6%) 
Kidney disinsertion of the prosthesis  1 (3.6%) 
Iatrogenic during a laparotomy   
Bladder fistula  7 (25%) 
Surgical revision  2 (7.1%) 
Complicated with suprapubic abscess  4 (14.3%) 
By tumor progression  1 (3.6%) 
Obstruction  3 (10.7%) 
Death from sepsis  2 (7.1%) 





Table 4 - Explantation of the DETOUR® prosthesis. Indications for, and time until the intervention.
Explanted prosthesis 
Indications  n (%)  Time (months) 
Infection  4 (14,3%)   
Candida albicans septicemia  2 (7,1%)  4 and 50 
Pseudomonas aeruginosa septicemia  1 (3,6%)  60 
Recurrent infections  1 (3,6%)  23 
Obstruction  3 (10,7%)   
With associated nephrectomy  2 (7,1%)  24 and 46 
Without nephrectomy  1 (3,6%)  64 
Persistent bladder fistula despite surgical revision  2 (7,1%)  15 and 23 





Table 5 - Statistical analysis of the risk factors for prosthesis failure (non-functional prosthesis, explanted prosthesis, death related to prosthesis).
Predictive factors for detour® prosthesis failure 
Risk factor  Functional prosthesis  Prosthesis failure  P -value  OR [IC] 
Age (> 66 years)  18  10  0.09  0.21 [0.04; 1.12] 
Gender         
Male  10     
Female  0.3  0.6 [0.13; 2.74] 
Radiotherapy         
Yes     
No  11  0.6  0.73 [0.14; 3.92] 
Chemotherapy         
Yes     
No  0.3  0.39 [0.08; 1.85] 
Bilateral prosthesis         
Yes     
No  13  10  0.3  0.87 [0.12; 6.24] 




References



Ganatra A.M., Loughlin K.R. The management of malignant ureteral obstruction treated with ureteral stents J Urol 2005 ;  174 (6) : 2125-2128 [cross-ref]
Elsamra S.E., Leavitt D.A., Motato H.A., Friedlander J.I., Siev M., Keheila M., et al. Stenting for malignant ureteral obstruction: Tandem, metal or metal-mesh stents Int J Urol 2015 ;  22 (7) : 629-636 [cross-ref]
Chung S.Y., Stein R.J., Landsittel D., Davies B.J., Cuellar D.C., Hrebinko R.L., et al. 15-year experience with the management of extrinsic ureteral obstruction with indwelling ureteral stents J Urol 2004 ;  172 (2) : 592-595 [cross-ref]
Kadlec A.O., Ellimoottil C.S., Greco K.A., Turk T.M. Five-year experience with metallic stents for chronic ureteral obstruction J Urol 2013 ;  190 (3) : 937-941 [cross-ref]
Savoie P.H., Laroche J., Vallier C., Fournier R. Réparations chirurgicales des lésions de l’uretère EMC-Tech Chir-Urol 2013 ;  6 (1) : 1-15[Article 41-125].
Netsch C., Becker B., Gross A.J. Management of ureteral obstruction: Value of percutaneous nephrostomy and ureteral stents Urol Ausg A 2016 ;  55 (11) : 1497-1510 [cross-ref]
Cordeiro M.D., Coelho R.F., Chade D.C., Pessoa R.R., Chaib M.S., Colombo-Júnior J.R., et al. A prognostic model for survival after palliative urinary diversion for malignant ureteric obstruction: a prospective study of 208 patients BJU Int 2016 ;  117 (2) : 266-271 [cross-ref]
Desgrandchamps F., Cussenot O., Meria P., Cortesse A., Teillac P., Le Duc A. Subcutaneous urinary diversions for palliative treatment of pelvic malignancies J Urol 1995 ;  154 (2 Pt 1) : 367-370 [cross-ref]
Clavien P.A., Barkun J., de Oliveira M.L., Vauthey J.N., Dindo D., Schulick R.D., et al. The Clavien-Dindo classification of surgical complications: five-year experience Ann Surg 2009 ;  250 (2) : 187-196 [cross-ref]
Loertzer H., Jurczok A., Wagner S., Fornara P. Prosthetic pyelovesical and pyelocutanous bypass. A palliative therapy concept in tumor-induced chronic hydronephprosis Urol Ausg A 2003 ;  42 (8) : 1053-1059 [cross-ref]
Muller C.O., Meria P., Desgrandchamps F. Long-term outcome of subcutaneous pyelovesical bypass in extended ureteral stricture after renal transplantation J Endourol 2011 ;  25 (8) : 1389-1392 [cross-ref]
Janitzky A., Borski J., Porsch M., Wendler J.J., Baumunk D., Liehr U.-B., et al. Long-term results for subcutaneous Detour prothesis for ureteral obstruction Urol Ausg A 2012 ;  51 (12) : 1714-1721 [cross-ref]
Jurczok A., Loertzer H., Wagner S., Fornara P. Subcutaneous nephrovesical and nephrocutaneous bypass Gynecol Obstet Invest 2005 ;  59 (3) : 144-148 [cross-ref]
Komiakov B.K., Guliev B.G., El’-Attar T.K., Serov R.A. Subcutaneous nephrovesical bypass in ureteral obstruction Urol Mosc Russ 1999 2009 ; 3-8
Wrona A.J., Zgajewski J., Kopeć N., Chodor D., Kopcza P., Klekot S. Subcutaneous pyelovesical bypass - Detour bypass - as a solution for ureteric obstruction Cent Eur J Urol 2017 ;  70 (4) : 429-433
Jabbour M.E., Desgrandchamps F., Angelescu E., Teillac P., Le Duc A. Percutaneous implantation of subcutaneous prosthetic ureters: long-term outcome J Endourol 2001 ;  15 (6) : 611-614 [cross-ref]
Desgrandchamps F., Leroux S., Ravery V., Bochereau G., Menut P., Meria P., et al. Subcutaneous pyelovesical bypass as replacement for standard percutaneous nephrostomy for palliative urinary diversion: prospective evaluation of patient's quality of life J Endourol 2007 ;  21 (2) : 173-176 [cross-ref]
De La Taille A.A., Zerbib M. Urologic complications of radiotherapy Ann Urol 2003 ;  37 (6) : 345-357 [cross-ref]
Almarzouq A., Andonian S. Spotlight - Management of pyelovesical bypass device stones Can Urol Assoc J J Assoc Urol Can 2018 ;  12 (5) : E267-E268
Wilhelm K., Schultze-Seemann W., Miernik A. Complete occlusion of a subcutaneous pyelovesical bypass graft (Detour® System) caused by uric acid stone formation Urol Int 2017 ;  98 (4) : 483-485 [cross-ref]
Bynens B.G., Ampe J.F., Denys H., Oyen P.M.V. Case report: relief of acute obstruction of the Detour subcutaneous pyelovesical bypass J Endourol 2006 ;  20 (9) : 669-671 [cross-ref]
Haddad N., Andonian S., Anidjar M. Simultaneous bilateral subcutaneous pyelovesical bypass as a salvage procedure in refractory retroperitoneal fibrosis Can Urol Assoc J J Assoc Urol Can 2013 ;  7 (5–6) : E417-E420 [cross-ref]
Dariane C., Cornu J.-N., Esteve E., Cordel H., Egrot C., Traxer O., et al. Fungal infections and ureteral material: how to manage? Progres En Urol J Assoc Francaise Urol Soc Francaise Urol 2015 ;  25 (6) : 306-311 [inter-ref]
Bazin D., Haymann J.-P., Letavernier E., Rode J., Daudon M. Pathological calcifications: a medical diagnosis based on their physicochemical properties Presse Medicale Paris Fr 1983 2014 ;  43 (2) : 135-148
Poulard C., Dessombz A., Daudon M., Bazin D. Duration of JJ stent in situ is critical: an ultrastructural and mechanical investigation Comptes Rendus Chim 2016 ;  19 (11) : 1597-1604 [inter-ref]
Daudon M., Dessombz A., Frochot V., Letavernier E., Haymann J.-P., Jungers P., et al. Comprehensive morpho-constitutional analysis of urinary stones improves etiological diagnosis and therapeutic strategy of nephrolithiasis Comptes Rendus Chim 2016 ;  19 (11) : 1470-1491 [inter-ref]
De Vries E.G., Meyer C., Strubbe M., Mulder N.H. Influence of various beverages on urine acid output Cancer Res 1986 ;  46 (1) : 430-432
Azhar R.A., Hassanain M., Aljiffry M., Aldousari S., Cabrera T., Andonian S., et al. Successful salvage of kidney allografts threatened by ureteral stricture using pyelovesical bypass Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 2010 ;  10 (6) : 1414-1419 [cross-ref]
Desgrandchamps F., Duboust A., Teillac P., Idatte J.M., Le Duc A. Total ureteral replacement by subcutaneous pyelovesical bypass in ureteral necrosis after renal transplantation Transpl Int Off J Eur Soc Organ Transplant 1998 ;  11 (Suppl 1) : S150-S151
Yazdani M., Gharaati M.R., Zargham M. Subcutaneous nephrovesical bypass in kidney transplanted patients Int J Organ Transplant Med 2010 ;  1 (3) : 121-124






© 2021 
Elsevier Masson SAS. Tous droits réservés.