[Direct cutaneous ureterostomy: a new technic. Preliminary results]

A current problem in urology involves the search for a method of high urine bypass which combines simplicity of application with therapeutic efficacy. A new technique of direct cutaneous ureterostomy is described which is applicable to both narrow and dilated ureters, and which prevents stenosis without catheterization. The originality of the method resides in the association of two previously described artifices. The first is related to the parietal crossing and involves interlocking of the aponeuroses of the external oblique and transverse abdominal muscles with resulting displacement of the internal oblique muscle fibers outside of the parietal course of the ureter. The second artifice concerns the ureterocutaneous anastomosis, with the formation of a skin flap in V sutured to the terminal portion of the axially incised ureter, the point of the V being attached to the apex of the incision. Ureteral vascularization must be respected and a sufficient length of ureter used to ensure anastomosis without traction. An indwelling ureteral catheter is maintained for one month, followed by urographic and ultrasonographic surveillance at progressively increasing intervals. This operative procedure was used in 23 patients (21 men and 2 women), age 48 to 74 years, with bladder cancer necessitating total enlarged cystoprostatectomy. Bilateral cutaneous ureterostomy was performed in 19 cases, and the unilateral operation (single kidney) in 4 patients. Of the 41 ureters on which a bypass was performed, 31 were initially narrow and 10 dilated. Overall results for 41 ureters showed that 34 (82,9%) were permeable after 18 months, a catheter having to be maintained in 7 cases only (17,1%).(ABSTRACT TRUNCATED AT 250 WORDS)