[Ureterosigmoidostomy and transcolonic cutaneous ureterostomy. Technical indications and results]

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.