Cutaneous uretero-ureterostomy: a technique of urinary diversion for high-risk patients with bladder cancer.
A simplified technique of cutaneous ureterostomy (CU) is presented for the treatment of high-risk bladder cancer patients. From 1968 to 2003, 2118 cystectomies with CU were performed for bladder cancer patients with uremic manifestations. The mean age was 67.4 +/- 27.3; 1206 patients were men and 912 were women. Cutaneous uretero-ureterostomy (CUU) was performed by three methods: (a) one ureter was brought across the midline and anastomosed end-to-side to the other ureter (end-to-side uretero-ureterostomy, ESUU); (b) the two ureters were placed side by side in a double-barrel fashion (double-barrel ureterostomy, DBU); or (c) the two distal ureteric ends were anastomosed together before fixation to the skin (side-to-side uretero-ureterostomy, SSUU). Selection of the technique depended on ureteric length and girth. No complications specific to CUU have occurred. Serum creatinine was normalized and intravenous pyelogram (IVP) showed improvement of obstructive manifestations and renal function. Ureterostomy stenosis was more common in ESUU than in DBU and SSUU; it responded to dilatation. This simple and easy procedure is shown to have a low rate of operative and postoperative complications and is indicated for high-risk patients with bladder cancer.
Shafik
Ahmed
A
Department of Surgery and Experimental Research, Cairo University, Cairo, Egypt.
Shafik
Ismail A
IA
El Sibai
Olfat
O
D000328:Adult; D000368:Aged; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014519:Ureterostomy / Q000379:methods* / Q000706:statistics & numerical data*; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods* / Q000706:statistics & numerical data*