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[Ureterosigmoidostomy and transcolonic cutaneous ureterostomy. Technical indications and results]
Insights
Transcolonic Ureterosigmoidostomy (US) is effective for children, especially with bladder exstrophy. Colonic conduit (CC) offers stable renal outcomes in higher-risk adults, outperforming ileal conduits.
Area of Science:
- Urology
- Surgical Techniques
- Pediatric Surgery
Context:
- Comparison of transcolonic Ureterosigmoidostomy (US) and colonic conduit (CC) urinary diversion techniques.
- Evaluation of outcomes in 127 US patients and 152 CC patients.
- Assessment of patient selection criteria and pre-existing renal conditions.
Purpose:
- To detail the experience and compare the efficacy of US and CC urinary diversion.
- To identify patient groups where each technique is most suitable.
- To analyze complication rates and renal unit outcomes for both procedures.
Summary:
- Transcolonic Ureterosigmoidostomy (US) showed high satisfaction in children, particularly for bladder exstrophy, with manageable complication rates.
- US yielded poor results in adults due to pre-existing upper urinary tract damage, contraindicating its use in this demographic and for cancer patients requiring radiotherapy.
- Colonic conduit (CC) with non-refluxing uretero-intestinal anastomoses demonstrated stable renal morphology in high-risk adult patients, with 79% showing improved ureteral dilatation and a 10% overall deterioration rate.
- CC exhibited favorable late complication rates (21% in children, 31% in adults with benign disease) compared to reported ileal conduit series.
Impact:
- US is a viable and satisfactory option for pediatric urinary diversion, especially in bladder exstrophy.
- CC provides a reliable alternative for adult urinary diversion, particularly in patients with compromised renal function or pre-existing urinary tract issues.
- Findings guide surgical decision-making for urinary diversion, optimizing patient selection for improved outcomes and reduced complications.
Abstract:
Experience with transcolonic Ureterosigmoidostomy (US) in 127 patients and colonic conduit (CC) in 152 patients is presented in detail. US proved to be highly satisfactory in children, in particular in bladder exstrophy (13% post-operative and 27% late complications, deterioration in 8% of all renal units), but gave poor results in adults. This was mainly due to the patient selection, as in this group preoperative damage to the upper urinary tract by pyelonephritis, obstruction, irradiation or previous surgery was frequent. Obviously these factors prohibit US. For the same reason US excludes adjunctive radiotherapy in cancer patients. Although employed in a higher renal risk group (signs of pyelonephritis in 34% and ureteral dilatation in 54% of the renal units in the preoperative IVP) CC with non-refluxing uretero-intestinal anastomoses reliably stabilized renal morphology (improvement of ureteral dilatation in 79%, over all deterioration 10% of all kidneys, mainly by progression of pyelonephritis established already before diversion). The low late complication rates of 21% in children and 31% in adults (with benign disease) compare favourably with the results reported in comparable series of ileal conduits.