Cutaneous ureterostomy in adults

Area of Science:

• Urology
• Surgical Oncology
• Palliative Care

Background:

• Metastatic carcinoma often necessitates urinary diversion due to ureteral obstruction.
• Existing methods like ureteral stents and nephrostomy tubes carry significant morbidity, particularly in debilitated patients.
• Intestinal urinary diversion is associated with higher risks, making it unsuitable for many patients.

Purpose of the Study:

• To evaluate the efficacy and safety of palliative cutaneous ureterostomy in adult patients with pelvic malignancy.
• To assess the procedure's role as an alternative to permanent nephrostomy or high-risk intestinal diversion.

Main Methods:

• A retrospective review of 29 adult patients (32 ureters) who underwent palliative cutaneous ureterostomy between 1974 and 1989.
• The technique involved transverse nephropexy and stoma construction using a skin flap.
• Indications included ureteral obstruction or severe urinary tract symptoms; hydroureter was not a prerequisite.

Main Results:

• Complications included one stroke-related death, one death from uremia and sepsis, and one case of renal failure due to renal arterial stenosis.
• Renal function was preserved in 10 long-term survivors (1-13 years postoperatively).
• Only 3 patients required stomal revision, and high rates of stomal stenosis were avoided by adhering to surgical techniques.

Conclusions:

• Palliative cutaneous ureterostomy is a valuable alternative for urinary diversion in carefully selected patients with pelvic malignancy.
• The procedure can be performed successfully even without pre-existing hydroureter.
• It offers a lower-risk option compared to permanent nephrostomy or intestinal urinary diversion for patients with a reasonable life expectancy.