Terminal loop cutaneous ureterostomy in cadaveric kidney transplantation

The presence of a nonfunctional bladder is a common finding in some patients with end-stage renal disease in whom transplantation is a proposed option. Over the last 20 years, we have performed six terminal loop cutaneous ureterostomies for urinary drainage during kidney transplantation. Neurogenic bladder in five patients and exstrophy in one patient prohibited use of the bladder. Four long-term graft survivors (19 months and 4, 10, and 20 years) experienced no short-term problems with the procedure, but two episodes of pyelonephritis have occurred. In our patients no graft dysfunction or loss could be attributed to infection, and no stomal stenosis or revision has occurred. We conclude that terminal loop cutaneous ureterostomy is feasible using normal-caliber ureters, and is a safe, effective means of urinary drainage during kidney transplantation when the bladder is not available. It also eliminates the necessity of preparatory bowel surgery that has its attendant risk of contamination in an immunocompromised patient.