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Related Experiment Videos

Cutaneous ureterostomy in adults.

G P Kearney1, S G Docimo, C J Doyle

  • 1Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Urology
|July 1, 1992
PubMed
Summary
This summary is machine-generated.

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Palliative cutaneous ureterostomy offers a viable alternative for urinary diversion in select cancer patients. This surgical technique can preserve renal function and avoid complications associated with other urinary diversion methods.

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.

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  • 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.