[Ureterotransversopyelostomy with unilateral nephrostomy]

Area of Science:

• Urology
• Surgical Oncology
• Oncologic Surgery

Context:

• Palliative urinary diversion is crucial for managing advanced pelvic malignancies and radiation-induced complications.
• Ureterotransversopyelostomy (UTPS) with unilateral nephrostomy offers a supravesical diversion technique.
• Patient selection is key, primarily involving advanced bladder cancer, fistulas, and other pelvic malignancies.

Purpose:

• To evaluate the efficacy and safety of ureterotransversopyelostomy (UTPS) with unilateral nephrostomy in a cohort of patients requiring palliative urinary diversion.
• To analyze the indications, surgical approach, complications, and outcomes associated with this diversion technique.

Summary:

• This study reports on 57 patients undergoing UTPS with unilateral nephrostomy, predominantly for advanced bladder cancer (25 patients) and radiation-induced fistulas (24 patients).
• The surgical approach involved an upper abdominal incision with varied ureteral anastomosis techniques and predominantly right-sided nephrostomy placement.
• The procedure demonstrated a low operative lethality (1.75%) and acceptable early (7%) and late (10.5%) complication rates, with nephrostomy and anastomotic stenoses being the most frequent issues.

Impact:

• UTPS with unilateral nephrostomy provides a valuable surgical solution for complex urinary diversion needs in palliative cancer care.
• Understanding complication patterns, such as nephrostomy issues and stenoses, can guide future surgical improvements and patient management.
• The study contributes to the evidence base for managing advanced pelvic malignancies and their sequelae, impacting treatment strategies and patient outcomes.