Laparoscopic cutaneous ureterostomy: technique for palliative upper urinary tract drainage

Area of Science:

• Urology
• Oncology
• Surgical Innovation

Background:

• Extensive pelvic carcinomatosis frequently causes bilateral ureteral obstruction, leading to renal parenchymal loss.
• Percutaneous nephrostomies are a palliative option but often poorly tolerated, necessitating alternative urinary diversion strategies.
• Laparoscopic techniques offer minimally invasive approaches for complex surgical reconstructions.

Observation:

• An elderly patient with advanced pelvic transitional cell carcinoma and a single functioning kidney experienced poor tolerance to repeated percutaneous nephrostomy tube replacements.
• A decision was made to pursue a more permanent urinary diversion using a cutaneous ureterostomy.
• Laparoscopic methodology was employed for the ureterostomy procedure.

Findings:

• The laparoscopic cutaneous ureterostomy was performed expeditiously.
• At 18 months postoperatively, the patient's unstented cutaneous ureterostomy remains functional.
• Serum creatinine levels remained normal, indicating preserved renal function.

Implications:

• Laparoscopic cutaneous ureterostomy is a viable and effective long-term urinary diversion for select patients with extensive pelvic malignancies.
• This approach can improve patient tolerance and quality of life compared to repeated percutaneous interventions.
• Minimally invasive surgery can achieve durable outcomes in challenging oncological cases.