[Palliative urinary diversion in inoperable pelvic tumors]

The problem raised is that of the legitimacy of palliative urinary derivation in the malignant tumours of the pelvis beyond any therapeutic possibility. Between 1980 and 1985, 49 patients were referred to the department of Urology of Rennes for cutaneous ureterostomy type. 39 records were suitable for review. Bilateral ureteric obstruction in the course of carcinomas of the pelvis, regardless of the origin, is uncommon bearing in mind the prevalence of such pathology and notably in women. Recent techniques (J catheter, per-cutaneous nephrostomy) have simplified the surgical procedure of urinary bypass. They do not fundamentally change the incisions and are not always applicable. Use of the J catheter may be prevented by the impossibility of intubating the ureter or when the bladder is unusable as a reservoir, whilst the use of percutaneous nephrostomy is hazardous or possibly even insufficient to dry the perineum when there is a malignant vesicovaginal fistula. This study involved evaluation of 39 patients who underwent uni or bilateral terminal cutaneous ureterostomy, any other technique having proved to be undesirable. The mean survival of the patients was 225 days and its quality as good or satisfactory in only 25% of cases. The implantation of epidural morphine reservoirs may improve the quality of survival of these patients by suppressing pain which up to now has been an absolute contraindication to an upper cutaneous derivation procedure.