Cystectomy in woman: what diversion? Cutaneous ureterostomy.
Urinary diversion after cystectomy in old and high risk patients is associated with major complications, exspecially those related to the type of urinary diversion. Ileal conduit and orthotopic bladder substitution have been the preferred option for urinary diversion after cystectomy. In patient with physiologic status classification determined by the American Society of Anesthesiologist (ASA) score, the complications related to the kind of diversion start to go up with ASA 3 patients. In patient ASA 3e, 4 and 4e ureterocutaneostomy represents a simplified choice for urinary diversion.


METHODS
At our department we performed 158 cystectomy from 2001 to 2005, 27 were female patient. In 5 (3.16%) patients ASA 4 and ASA 4e we choosed ureterocutaneostomy.


RESULTS
One patient died of myocardial infarction in intensive postoperative care unit and one patient had a serious stenosis of the ureter.


CONCLUSIONS
cutaneous ureterostomy after cystectomy may be indicated for patients ASA 3e, 4 and 4e. Operative risk is low. The first indication is for dilated ureters and not irradiated pelvis.
Bondavalli
Candido
C
Department of Urology "C.Poma" Hospital, Mantua, Italy. urologia.mantova@virgilio.it
Cappellaro
Livi
L
D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D014519:Ureterostomy