[Urinary diversion in cystectomy in bladder cancer patients]

From 1985 to 1991 the author operated on 21 bladder cancers, forming cross anastomoses on the upper urinary tracts. 19 patients underwent cystectomy. Stage T2, T3, T4 was diagnosed in 4.8%, 80.9% and 14.3% of the patients, respectively. Hydroureteronephrosis was detected in all the patients, chronic pyelonephritis developed in 16 (76.2%), chronic renal failure in 9 (42.9%). Upper and low transureteroureteronephrostomy (TUUN) was performed in 13 (61.9%), transureteropyelonephrostomy (TUPN) in 3 (14.3%), transureteropyelo-ureterosigmoidostomy in 5 (23.8%) patients. The latter technique implies successive connection of the kidneys with the sigmoid. This provided less exposure of one of the kidneys to the intestinal infection, urinary fistulas did not form. Two deaths in the postoperative period were due to metastases and thromboembolism. The authors believe that the best functional conditions for the kidneys are secured by upper TUUN, TUPN and transureteropyelo-ureterosigmoidostomy applicable in cystectomy and in normal tonicity of the upper urinary tracts.