Transureteroureterostomy with cutaneous ureterostomy for permanent urinary diversion

Transureteroureterostomy with cutaneous ureterostomy was used for permanent urinary diversion in 18 patients. No early complications occurred, but late complications arose in two patients. Because of its simplicity, this procedure should receive more frequent consideration for permanent urinary diversion. A low complication rate can be achieved by adherence to certain technical principles.     

Clinical results of tubeless cutaneous ureterostomy by Toyoda's method

Tubeless cutaneous ureterostomy by Toyoda's method was conducted in 67 ureters from 43 patients during the last 9 years. Subjects included 30 males and 13 females, with an average age of 61.4 years. Most of them were afflicted with malignant tumors in the bladder, rectum, prostate, or uterus. For bilateral ureterostomy, the double-barrel method was performed in which the stoma was made at the same site in both the right and left ureters. Among 60 ureters in which pre- and postoperative changes in the renal pelvis could be traced by IVP, satisfactory results were obtained in 16 of 20 ureters treated by unilateral surgery. Of the 40 ureters treated by the double-barrel method, moderate or severe pyeloectasis was observed in 3 of the 20 ureters on the side of the stoma, while moderate pyeloectasis was seen in 3 of 20 ureters of the side opposite the stoma, and severe pyeloectasis or loss of renal function was noted in 5. Thus, renal function on the side opposite the stoma was frequently influenced by the procedure. A patient who died of disseminated intravascular coagulation syndrome soon after the operation was excluded from analysis. Tubeless cutaneous ureterostomy could be conducted in 39 of 42 patients (92.8%), excluding one whose stoma and its periphery were covered with severe inflammatory granulation and 2 with ureteral constriction.     

Modified technique for improving tubeless cutaneous ureterostomy by Ariyoshi method

Objectives:   The cutaneous ureterostomy is the simplest urinary diversion method; however, it often causes stomal stenosis, requiring sustained catheterization with regular catheter exchange. In an attempt to prevent stomal stenosis after surgery, the fascia (S-U fascia) between the spermatic cords and the ureters, which is usually cut off, was preserved. The remaining capillaries in the fascia could supply blood to the ureters, which is one of the most important factors for ureter patency.
Methods:   In 58 patients (93 renal units) undergoing cutaneous ureterostomy, 36 patients (66 renal units) were treated by the modified technique.
Results:   The surgeries carried out with the modified technique were significantly different in the type of operation, the side relationship, and the catheter-free rate using the univariate analysis by means of the predicted tests, in comparison with 22 patients (27 renal units) that were treated with the conventional technique. Multivariate analysis for the type of operation determined that of the side relationship and the method, only the latter was a significant factor. The modified method allowed ∼90% of the patients to have a catheter-free life; otherwise 74% of the patients had stomal stenosis, followed by catheterization.
Conclusion:   The presented cutaneous ureterostomy technique to preserve the fascia is useful not only to prevent stomal stenosis and maintaining good quality of life without catheterization, but also to apply to other types of ureter surgery.     

Terminal loop cutaneous ureterostomy in renal transplantation: an under utilized urinary diversion technique

PURPOSE: We evaluated the effectiveness of terminal loop cutaneous ureterostomy as a means of urinary drainage in kidney transplant recipients during a 20-year period. MATERIALS AND METHODS: Five cadaveric and 2 living related patients underwent kidney transplantation with terminal loop cutaneous ureterostomy between 1984 and 2004. These patients had no usable bladder or they were not suitable candidates for intermittent catheterization. RESULTS: Followup was 20 months to 17 years. One patient underwent stomal revision 5 months after renal transplantation. Current serum creatinine 4 years later was 166 mumol/l. The remaining 6 patients had no evidence of ureteral obstruction and rarely had bacteriuria or urinary tract infections. Four patients had a functioning allograft with normal serum creatinine. One patient died with a normally functioning allograft and the remaining patient lost his graft due to chronic rejection. No patient in this series lost the graft due to a urological cause. Overall outcomes included excellent allograft function with minimal infection or stomal stenotic complications. CONCLUSIONS: Terminal loop cutaneous ureterostomy is a simple, safe and alternative means of urinary diversion in patients with renal transplant and a defunctionalized lower urinary tract.     

Cutaneous ureterostomy as a permanent external urinary diversion in children

Permanent cutaneous ureterostomy was used in 20 children between 1967 and 1980. The result was excellent in 15 cases (75 per cent) and acceptable in 2 (10 per cent), with better results for those patients who underwent cutaneous ureterostomy with transureteroureterostomy. Upon reviewing our 3 failures and 8 from another group it became clear that the amount of ureteral dilatation present preoperatively was inadequate for this type of diversion in 5 of the 11 cases. Overall, poor results were common in patients less than 2 years old and in those with recurrent symptomatic infection or impaired renal function before diversion. There was no late deterioration, since the onset of problems always occurred within 3 years of diversion.     

Extraperitoneal bilateral tubeless cutaneous ureterostomy with umbilical stoma

In some patients with intractable symptoms from incurable pelvic cancer, for example, urgency, severe hematuria, fistula formation and hydronephrosis, palliative urinary diversion with intestinal segments may not be available. Percutaneous nephrostomy or indwelling of double-J ureteral stents were usually performed. However, they suffered catheter trouble and their quality of life considerably worsened. Therefore, we developed a new technique of bilateral extraperitoneal tubeless cutaneous ureterostomy with single umbilical stoma. It resulted in symptom relief in 3 patients. The advantage of this method was as follows. The dissection was entirely extraperitoneal. The operative time was short and the procedure could be performed easily. The left ureter need not be led behind the mesosigmoid. Finally, ostomy care was easy with only one bag.     

腹膜外膀胱全切输尿管皮肤乳头术：附17例报告

自１９９０年１１月－１９９３年１１月，对１７例膀胱癌患者实行腹膜外膀胱全切输尿管皮肤乳头术。术后随访１４例，平均随访１３个月，随着时间的延长，４例皮肤乳头有不同程度萎缩。７例术前伴肾积水者中有５例在术后２－５个月恢复正常，２例明显好转。所有病人肾功能均正常，无明显尿路感染，本术式具有操作简单，不干扰肠道，安全性大，并发症少，术后恢复快等优点。尤其适用于不能耐受大而复杂的尿流改道手术的高危患者。     

Intubated cutaneous ureterostomy: option for high-risk patients needing supravesical urinary diversion

Failure of primary healing between ureter and skin has led to numerous complications and the virtual abandonment of cutaneous ureterostomy. When an indwelling double-J stent can be maintained, primary healing occurs and good ureterocutaneous anastomoses result. Ostomy training is only slightly more difficult than in patients with an ileal conduit urinary diversion and has presented no major problems. We now favor cutaneous ureterostomy in selected high-risk patients because of the lesser magnitude of this form of supravesical urinary diversion and, especially, because intubation has overcome most of the complications of this procedure.     

Clinical outcome of tubeless cutaneous ureterostomy by the Toyoda method

AIM: Cutaneous ureterostomy is the least invasive method of urinary diversion, but it carries a risk of stomal stenosis. We retrospectively examined the long-term outcome of tubeless cutaneous ureterostomy by the Toyoda method. METHODS: Since 1983, the Toyoda cutaneous ureterostomy has been performed in 97 patients (169 renal units) with a minimum follow up of 3 months. The ureteral patency rate was reviewed according to whether the stomal type was single (one ureter, one stoma) or double-barrel (two ureters, one stoma). RESULTS: After a median follow up of 23 months (range 3 to 169), a tubeless condition was achieved in 102 (82%) of 124 renal units associated with double-barrel stoma and in 35 (78%) of 45 renal units associated with single stoma. Although mild to moderate hydronephrosis was observed in 19% of patients, serum creatinine levels did not change after a minimum of 12 months after surgery (median 35). CONCLUSIONS: A high ureteral patency rate was achieved with cutaneous ureterostomy using the Toyoda method. This procedure, especially double-barrel stomal creation, is a reasonable alternative to other forms of urinary diversion in patients at high risk.     

Loop cutaneous ureterostomy as a method of urinary diversion in the adult.

A loop cutaneous ureterostomy was performed as an emergency treatment in 6 patients with bladder or prostatic cancer. Out of 9 operated ureters, only one stenosis was observed. Infection is a possible complication which can sometimes alter the renal function.     

A new modification of tubeless cutaneous ureterostomy following radical cystectomy

Purpose

Cutaneous ureterostomy is a well-established surgical technique of incontinent urinary diversion treatment. However, stoma stenosis limits widespread utilization of this technique. We present our modification of constructing single-site tubeless cutaneous ureterostomy aiming to reduce stomal complications and improve catheter-free rate of those patients.

Materials and methods

In 2016–2017, 30 patients with 60 renal units underwent modified and 30 patients with 60 renal units standard technique. The main differences of our method from previously described techniques were the preservation of parietal peritoneum and fixation of ureteral orifices one to another. Catheter-free rate was calculated in all patients with a minimum follow-up period of 12 months. In total, 52 patients, 26 from the modified cutaneous ureterostomy group, and 26 from the standard cutaneous ureterostomy group were available for the final analysis.

Results

The patients’ mean age was 63.1 years. The median follow-up period was 25.8 months (ranging from 1–37 months). The catheter-free rate was achieved 76.9% (20 patients) in the modified group compared to 42.3% (11 patients) in the standard group (P value?=?0.013). No statistically significant differences were observed between two groups for late complications and readmission rates.

Conclusions

Our technique of single-site-modified cutaneous ureterostomy is a safe and simple surgical technique with similar postoperative complications rate and better catheter-free rate compared to standard cutaneous ureterostomy. We believe that this technique could be a method of choice not only for candidates for cutaneous ureterostomy but also for selected patients for ileal conduit.