[Ureterotransversopyelostomy with unilateral nephrostomy]

Supravesical urinary diversion by ureterotransversopyelostomy (UTPS) with unilateral nephrostomy was performed in 57 patients. The age of the 33 women ranged between 42 and 86 (mean 65), of the 24 men between 39 and 77 (mean 62) years. With a single exception, the indication for diversion was palliative: 25 patients had advanced bladder cancer (T3/T4), and 19 had undergone irradiation; 24 patients showed vesico- (recto-) vaginal fistulas due to radiation for gynecological carcinomas. In 2 patients, the indication was urge-incontinence following former radiation therapy for uterine cancer, whereas 5 patients had advanced malignancies originating in the urethra, prostate, rectum or ovaries. The only case without malignant disease exhibited a contracted bladder of uncertain origin, together with an immunodeficiency syndrome. The approach used was an upper abdominal cross incision. In 35 patients, an anastomosis was done between the ureter and contralateral renal pelvis; in 22, a terminoterminal ureteral anastomosis was performed. For placement of the nephrostomy (49 terminal, 8 U-tube nephrostomies) we preferred the right side in 41 of 57 cases. The mean follow-up time in the 22 surviving patients was 36 months (range 2-108); the mean survival time in the 30 deceased patients was 12 months (range 0.5-87). With 4 exceptions, the cause of death was progression of the underlying tumors. Operative lethality was 1.75%, early surgical complication rate 7%, and rate of severe late complications 10.5%. The most frequent problems arose from the nephrostomy and from stenoses of the ureteropelvic or ureteral anastomosis.(ABSTRACT TRUNCATED AT 250 WORDS)