Modified technique for improving tubeless cutaneous ureterostomy by Ariyoshi method.
OBJECTIVE
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 approximately 90% of the patients to have a catheter-free life; otherwise 74% of the patients had stomal stenosis, followed by catheterization.


CONCLUSIONS
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.
Wada
Yoshihiro
Y
Department of Urology, Graduate School of Medical Sciences, Kumamoto Unviersity, Kumamoto, Japan. pullpullachan326@bridge.ocn.ne.jp
Kikuchi
Ken
K
Imamura
Takahisa
T
Suenaga
Takatoshi
T
Matsumoto
Koichiro
K
Kodama
Kodo
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005205:Fascia; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013085:Spermatic Cord; D054047:Surgical Stomas / Q000009:adverse effects; D014519:Ureterostomy / Q000379:methods*