Cutaneous Uretero-Ureterostomy: A Technique of Urinary Diversion for High-Risk Patients with Bladder Cancer

Publication:

Surgical Technology International XVI - Urology

Article title:

Author(s)

Ahmed Shafik, M.D., Ph.D.
Professor and Chairman
Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt

Ismail A. Shafik, M.Ch., M.D.
Lecturer in Surgery
Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt

Olfat El Sibai, M.D., Ph.D.
Professor and Chairman
Department of Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt

Abstract

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.