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PubMedDate not supplied

[Reconsideration of transureteral cutaneous ureterostomy: Y-shaped cutaneous ureterostomy (author's transl)].

After reviewing the history and technique used for transureteral cutaneous ureterostomy, the authors describe 5 cases treated by this method during the 3-year period, 1975--1977. This prodecure has many advantages when compared to the transintestinal cutaneous ureterostomy as described by Bricker, uteterosigmoidoscopy, and "double-barreleed" cutaneous ureterostomy. The authors conclude that transureteral cutaneous ureterostomy should be performed in cases of ureteropyelocalicial distention with renal failure from operable or inoperable bladder cancer, in women with inoperable or recurrent tumors of the genital organs and vesicovaginal, vesicourethrovaginal or vesicorectovaginal fistulae, and in patients with a neurological bladder. They propose that this surgical technique be known as "Y-shaped cutaneous ureterostomy" instead of transureteral cutaneous ureterostomy because of its similarity to the method of Roux for Y-shaped digestive tract anastomoses, and because this new terminology is simpler and describes the operative procedure in a clearer manner.

Aged↗
PubMed1981

Uretero-ureterostomy, transuretero-ureterostomy.

The authors describe various possibilities of using uretero-ureterostomy in cases of healthy bladder an in cases of supracystic urinary diversion. The history and the technique of the operation are described. Attention is called to the direction of anastomosis in cases of ureters differing in the width of their lumen. Clinical observations of 21 cases of uretero-ureterostomy are reported. In 17 cases transuretero-uretero-cutaneostomy was done. Stenosis of the recipient ureter did not develop in any of these cases. The main complication in transuretero-ureterostomy was stenosis of the foramen of ureterocutaneostomy. For avoiding this complication of transuretero-ureterocutaneostomy only wide-lumen ureters should be anastomosed to the skin.

Adult↗
PubMed1976

Experimental study of synadelpho-ureterostomy (transuretero-ureterostomy).

An experimental study with synadelpho-ureterostomy (transuretero-ureterostomy) was performed in 25 dogs. The conclusions reached are: (1) side-to-side anastomosis is to be preferred to end-to-side suture; (2) risk of disruption is very slight even where an unexpected obstruction is encountered (test with induced cellophanic periureteritis), and (3) segmental replacement of the lumbo-iliac ureter may apparently be achieved by means of inverted synadelpho-ureterostomy (the damaged ureter is the recipient ureter). This replacement requires a double synadelphostomy, but in our study the normal transposed ureter suffered no harm despite the presence of previous infection and ureteral dilatation.

Animals↗
PubMed1984

[Cutaneous transuretero-ureterostomy or cutaneous Y-ureterostomy. Apropos of 14 cases].

Cutaneous transureterostomy was performed in 14 patients, this bypass procedure being necessary in 9 cases for neoplasm (7 after total cystectomy) and in 5 patients for non-neoplastic lesions. The simplicity of this method is emphasized, particularly when compared with Bricker's operation, beneficial effects with respect to the comfort of the patient being similar. However, at least one ureter must be dilated: one failure of treatment was due to narrow ureters and a repeat operation was necessary to exteriorize each ureter on to the skin. The essential problem concerns the skin stoma, if an apparatus is to be fitted without a catheter. In 8 of 12 patients the cutaneous ureterostomy remained patent without artificial assistance. Two operated cases required ureteral catheters, while two others had prosthetic replacement of the foot of the ureterostomy in Y. One patient died after cystectomy for cancer. A new cutaneous and aponeurotic reconstructive mode appears capable of guaranteeing more consistent results.

Adult↗
PubMed1994

Current indications for cutaneous ureterostomy.

OBJECTIVE: To assess the current indications for cutaneous ureterostomy in children. METHOD: A total of 32 children underwent cutaneous ureterostomy at Texas Children's Hospital from 1975 to 1990. Medical records were reviewed to determine the urologic diagnosis, the indication for urinary diversion, the type of ureterostomy performed, and the outcome for each patient. RESULTS: Twenty patients underwent loop cutaneous ureterostomy (LCU) or pyelostomy and 12 patients underwent end cutaneous ureterostomy (ECU). The main indication for LCU was obstructive uropathy unresponsive to lower urinary tract drainage, and the most common cause was posterior urethral valves. Other indications for LCU included obstruction requiring delayed surgical correction, high-grade reflux into a solitary kidney, and obstruction with infection. The children who required ECU were an older, more diverse group than those who underwent LCU. The main indication for ECU was poor bladder function secondary to a variety of congenital anomalies, including prune-belly syndrome, posterior urethral valves, bladder exstrophy, and urogenital sinus defect. CONCLUSION: LCU is easy to perform and is an excellent method for achieving temporary upper urinary tract drainage. ECU is suited for long-term or permanent urinary diversion in children with at least one dilated ureter, and can provide a socially acceptable stoma when delayed reconstruction is necessary. Many children who were "permanently" diverted by ECU may be undiverted using newer reconstructive techniques.

Child, Preschool↗
PubMed2000

Successful long-term outcome using existing native cutaneous ureterostomy for renal transplant drainage.

PURPOSE: We report our long-term experience with a preexisting native cutaneous ureterostomy via an ipsilateral transplant ureteral native ureterostomy for transplant drainage without native nephrectomy. MATERIALS AND METHODS: Between 1993 and 1998, 5 patients without a usable bladder had undergone previously urinary diversion via cutaneous ureterostomy. All patients had a well functioning cutaneous ureterostomy for a mean plus or minus standard deviation of 18+/-12 years before renal transplantation. No patient had a history of stomal stenosis, recent urinary tract infection or pyelonephritis. RESULTS: All 5 patients continued to have a functioning renal transplant at last mean followup of 36+/-6.6 months. Complications included stomal retraction due to postoperative weight gain requiring revision in 2 cases and ureteroureteral anastomotic stenosis treated with endopyelotomy in 1. Mean serum creatinine at last followup was 1.5+/-0.6 mg./dl. CONCLUSIONS: Of the complications that we present only 1 may be attributed to the singularity of our procedure. Our experience suggests that a preexisting native cutaneous ureterostomy may serve as a receptacle for transplant ureteral drainage in select patients with excellent long-term function.

Adult↗
PubMed2005

Simple technique for improving tubeless cutaneous ureterostomy.

INTRODUCTION: Cutaneous ureterostomy is the simplest and safest method of all permanent urinary diversions. However, the procedure does carry a risk of stomal stenosis. We describe a simple technique for improving tubeless cutaneous ureterostomy. TECHNICAL CONSIDERATIONS: Between June 1991 and June 2003, the Toyoda cutaneous ureterostomy was performed in 54 patients (102 renal units) with a minimum of 6 months of follow-up. Since 1998, we introduced a new technique, consisting of fixation between the anterior and posterior rectus sheath by four interrupted sutures to maintain the stability of the abdominal wall tunnel for the ureters. The ureteral patency rate was reviewed. Of the 79 renal units (77.5%) that achieved a tubeless condition, 70 (68.6%) had no hydronephrosis. The catheter-free rate improved from 60.5% (26 of 43 renal units) to 89.8% (53 of 59 renal units) with the introduction of the new surgical stabilization step for the abdominal wall tunnel. CONCLUSIONS: This surgical modification is an effective and simple procedure that improves tubeless cutaneous ureterostomy performed with the Toyoda method.

Humans↗
PubMed2000

The management of children with complete ureteric duplication: selective use of uretero-ureterostomy as a primary and salvage procedure.

OBJECTIVE: To determine the optimum management of duplex urinary tracts with refluxing or obstructed units. PATIENTS AND METHODS: Sixty-three children (19 boys and 44 girls) with complete duplex-system anomalies (84 duplex system units) who underwent corrective surgery by one surgeon (H.C.) between March 1983 and June 1997 were reviewed, analysing their diagnosis and treatment. RESULTS: Most children had presented with urinary tract infection; a ureterocele was found in 26 renal units, reflux in 12 and a combined anomaly in 18. Ectopic insertion of the ureter causing incontinence was found in six and ureteric obstruction in nine ureteric units. Patients were managed so that whenever possible, functional renal tissue was preserved; thus surgical strategies were basically staged, conservative, and planned preoperatively on the basis of renal function. Initial surgery was undertaken in 71 units (all patients; ureterocele incision in 12, upper pole nephrectomy in 30, ureteric reimplantation in 14, uretero-ureterostomy in 13 and others in two). The median (range) follow-up was 7.6 (2.1-16) years. Secondary procedures were undertaken in 24 units (34%); ureterocele incision (11 of 12 units) was the most common procedure of additional surgery, followed by ureteric reimplantation (six of 27 units), upper pole nephrectomy (eight of 37 units) and uretero-ureterostomy (two of 18 units). CONCLUSIONS: Uretero-ureterostomy was the most successful nephron-sparing additional operation. When the upper pole is salvageable, uretero-ureterostomy may be the preferred alternative for managing complete duplex system anomalies.

Adolescent↗
PubMed2006

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.

Adult↗
PubMed1989

Biocarbon ureterostomy device for urinary diversion. Multicenter clinical trial.

The bioCarbon ureterostomy device is a stomal prosthesis for upper tract urinary diversion that has had preliminary successes in animal and human trials in Europe and Peru. Implantation of a pure carbon stomal prosthesis offers the potential advantages of high biocompatibility, lack of encrustation, and elimination of stomal stenosis which is frequently associated with cutaneous ureterostomy. Nine bioCarbon ureterostomy devices were implanted from August, 1984 through July, 1985. Although successful implantation was achieved in 2 patients, the complication rate was high. The bioCarbon ureterostomy device has potential as an alternative form of urinary diversion. However, significant problems need to be remedied before it can be recommended for routine clinical application.

Aged↗
PubMed1978

Posterior urethral valves managed by cutaneous ureterostomy with subsequent ureteral reconstruction.

Six boys, 2 weeks to 5 years old, underwent cutaneous ureterostomy for massively dilated upper urinary tracts secondary to obstruction by posterior urethral valves. Cutaneous ureterostomies had been performed elsewhere in 2 patients. Two patients underwent transurethral fulguration of the valves initially with no improvement. Blood urea nitrogen, creatinine and serum electrolyte values continued to increase and, therefore, cutaneous ureterostomies were performed with dramatic improvement. Two patients presented with sepsis, one of whom had a positive blood culture. Both children had severe pyonephrosis and after the conditions improved with medical treatment cutaneous ureterostomies were done. The total number of surgical procedures required for all patients was 59, including renal biopsies, nephrostomies and cystoscopies. No kidneys, except for the severely dysplastic ones, were lost and all patients resumed normal growth rates and have had no urinary tract infections. All laboratory values are within normal limits.

Blood Urea Nitrogen↗
PubMed1977

Surgical treatment of the massively dilated ureter in children. Part I. management by cutaneous ureterostomy.

One of the major therapeutic challenges facing the pediatric urologist is the massively dilated ureter. When conservative measures, such as relief of obstruction or treatment of infection, have failed or are likely to fail, surgical treatment must be directed at the massive dilatation itself. These circumstances were encountered in 366 massively dilated ureters in 244 children during a 10-year period. Loop and/or terminal cutaneous ureterostomy was used to manage 125 of these ureters in 74 children. Indications for temporary non-intubated proximal urinary diversion included uncontrolled infection, sepsis, azotemia, significant ureteral redundancy and tortuosity, and questionable over-all renal function. Advantages of loop ureterostomy included more proximal drainage and less stomal problems but terminal ureterostomy required a significantly lesser number of surgical procedures in reconstructing the urinary tract. Temporary splinting of the ureter in dry ureteral reimplantations has diminished markedly the incidence of ureterovesical complications. No instances of permanent vesical contracture were noted after long periods of defunctionalization. After initial reconstruction of 47 cutaneous ureterostomies good results by all parameters were obtained in 68 per cent. Additional surgical procedures in selected initial failures have resulted in a final success rate of 85 per cent.

Dermatologic Surgical Procedures↗