Volume 52, Issue 1, Pages 193-198 (July 2007) The Detour Extra-Anatomic Stent—a Permanent Solution for Benign and Malignant Ureteric Obstruction?  Stuart N. Lloyd, Prasanda Tirukonda, Chandra Shekhar Biyani, Tze M. Wah, Henry C. Irving  European Urology  Volume 52, Issue 1, Pages 193-198 (July 2007) DOI: 10.1016/j.eururo.2006.11.008 Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 1 (a) A new lateral percutaneous track is created for the proximal insertion of the Detour stent because the patient’s existing track is too posteriorly located. (b) The proximal end of the stent is inserted through the 30F amplatz sheath. European Urology 2007 52, 193-198DOI: (10.1016/j.eururo.2006.11.008) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 2 The radio-opaque ring marker is sited at the junction of the calyx with renal parenchyma. European Urology 2007 52, 193-198DOI: (10.1016/j.eururo.2006.11.008) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 3 The large-bore plastic hollow tube is used to create a subcutaneous tunnel from the loin to the subrapubic region. European Urology 2007 52, 193-198DOI: (10.1016/j.eururo.2006.11.008) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 4 The bladder is accessed through a Pfannensteil rectus splitting incision, and a small open cystotomy is performed following retrograde bladder distension. The inner silicone tube, with a few small perforations, is inserted into the bladder, and the outer polytetrafluoroethylene tube is secured onto the blader wall with 4-0 Vicryl sutures. European Urology 2007 52, 193-198DOI: (10.1016/j.eururo.2006.11.008) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 5 All incisions are sutured at the end of the procedure in a patient following insertion of the stent, which has rendered the patient “tubeless” and “bagless”. European Urology 2007 52, 193-198DOI: (10.1016/j.eururo.2006.11.008) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 6 This cystogram confirms the patency of the stent with free reflux of contrast from the bladder into the collecting system with no leaks. European Urology 2007 52, 193-198DOI: (10.1016/j.eururo.2006.11.008) Copyright © 2006 European Association of Urology Terms and Conditions