Uretero-ureterocutaneostomy (wrapped by omentum)

Area of Science:

• Urology
• Surgical Oncology

Background:

• High-stage bladder cancer in elderly, high-risk patients presents significant treatment challenges.
• Palliative cystectomy is considered for symptomatic relief in advanced disease.
• Urinary diversion is a critical component of palliative cystectomy.

Purpose of the Study:

• To evaluate the efficacy and safety of a modified uretero-ureterocutaneostomy (UUC) technique.
• The technique involves omental wrapping for urinary diversion after palliative cystectomy.
• Focus on symptomatic, elderly, high-risk patients with high-stage bladder cancer.

Main Methods:

• A cohort of 15 elderly, high-risk patients (ASA score 3) with T2/T3 bladder cancer underwent palliative cystectomy.
• A modified UUC procedure was performed, mobilizing ureters and creating a stoma.
• Omental wrapping was utilized to protect and support the ureteric stumps at the skin level.

Main Results:

• The modified UUC procedure demonstrated a safe and uncomplicated postoperative course in 14 of 15 patients.
• Median follow-up was 15 months, with minimal upper tract dilatation reported.
• Stoma care was managed effectively at home, with J-catheters used for occasional obstruction.

Conclusions:

• Modified uretero-ureterocutaneostomy with omental wrapping is a simple, safe, and effective palliative urinary diversion method.
• This technique offers favorable outcomes for high-risk patients undergoing cystectomy for advanced bladder cancer.
• The procedure leads to uneventful recovery and manageable long-term stoma function.