Laparoscopic cutaneous ureterostomy: technique for palliative upper urinary tract drainage

Extensive pelvic carcinomatosis often results in bilateral ureteral obstruction and renal parenchymal loss. Percutaneous nephrostomies can be used for palliative means but may be poorly tolerated. Laparoscopic techniques can be applied to obtain a more permanent urinary diversion. An elderly gentleman with extensive pelvic transitional cell carcinoma of the bladder and only one functioning renal unit underwent percutaneous nephrostomy tube placement in combination with palliative cytoreductive radiation therapy. Poor patient tolerance led to repetitive nephrostomy tube replacement. A cutaneous ureterostomy was chosen as a more permanent urinary diversion, and laparoscopic techniques allowed this to be accomplished expeditiously. At 18 months postoperatively, the patient's unstented cutaneous ureterostomy is functioning well, and the serum creatinine concentration remains normal.