Biplanar extra- and trans-peritoneal ureterocutaneostomy by laparoscopy (BETUL)

Although rare, incontinent diversions still has a place in the management of challenging conditions. Ureterocutaneostomy (in refluxing or non-refluxing moieties) is a viable option for relief of obstruction. It can be performed open or laaproscopically. Here we report our laparoscopic technique of extraperitoneal cutaneous ureterostomy with the help of transperitoneal laparoscopy.

The patients who underwent laparoscopic ureterocutaneostomy between 2020 and 2024 are enrolled in the study and our hybrid technique is described.

Seven patients are enrolled in the study with a mean age of 60,57 ± 26,53 (12 days-16 years). Indications were bladder outlet obstruction, VUR and obstructing megaureter. Six patients received unilateral, 1 patient bilateral diversion. Sober Y ureterostomy was performed in 6 patients and loop ureterostomy in 1. One patient 1 unilateral Y ureterostomy needed stoma revision surgery for stenosis.

One 5 mm optical port was inserted from the umblicus. After inspection and deciding the stoma site, another port (3 or 5 mm) was inserted staying outside the peritoneum if possible. This port is directed to the ureter bluntly. If necessary, another 3 or 5 mm assistant port is introduced. The ureter is grasped and taken out through the port site and stoma is reconstructed outside. For Y ureterostomy; ureter is divided, one end is reserved for stoma and the other is anastomosed the other limb in an end-to-side fashion. For loop ureterostomy, one side of the ureteral wall is opened and reconstructed as standard loop stoma.

Uretero-cutaneostomy is not a common procedure in children and surgical approach should be individualised for each patient as indications vary significantly as well as the anatomy of every single patient. Transperitoneal laparoscopic approach provides evaluation of the anatomy of the patient, extended vision and magnification, and guiding the decision of the proper site for the stoma.