[Direct cutaneous ureterostomy with myoplasty using a pedicled flap of the rectus abdominis]

Many methods have been reported to prevent the development of stomal stenosis following direct cutaneous ureterostomy, thus avoiding catheterizations with their attendant complications, and improving patient tolerance. Nevertheless, although lessened, the risk of stenosis persists in narrow ureters. In order to improve local trophicity and help maintain a wide, flexible intraparietal segment, the authors have developed a technique of cutaneous ureterostomy using a muscle flap from the rectus abdominis muscle and a V-shaped skin flap. This procedure was used on 20 ureters, including 12 dilated ureters and 8 narrow ureters. Follow-up was 3 months to 2 years. In 18 cases, no catheterization was needed, and no stenoses or complications were observed. In one case, stomal stenosis developed on a dilated, irradiated ureter from a non-functioning kidney. An indwelling catheter was used in one narrow ureter with a stenosis proximal to the abdominal wall. These preliminary results suggest that this technique is beneficial. Further studies with a larger number of patients and longer follow ups are needed.