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[Ureterosigmoidostomy in adults: long term results]
A E Mottaz1, E J Zingg, U E Studer
1Clinique Universitaire d'Urologie, Berne, Suisse.
Insights
Ureterosigmoidostomy offers good long-term functional results for bladder cancer patients, with high rates of continence and satisfactory quality of life. Careful follow-up is crucial for managing potential complications.
Area of Science:
- Urology
- Oncology
- Surgical Outcomes
Context:
- Ureterosigmoidostomy is a surgical procedure for urinary diversion in patients with invasive bladder cancer.
- Long-term outcomes and quality of life following this procedure require thorough evaluation.
Purpose:
- To assess the long-term complications and functional outcomes of ureterosigmoidostomy in patients with invasive bladder cancer.
- To evaluate continence and quality of life in patients who survived over 5 years post-surgery.
Summary:
- This study reviewed 65 patients who underwent ureterosigmoidostomy between 1971 and 1992.
- Early complications included pyelonephritis and acidosis; late complications involved pyelonephritis, stenosis, acidosis, incontinence, and anastomotic cancer.
- Among 26 patients surviving over 5 years, 88% reported daytime continence, 54% nighttime continence, and 92% satisfactory quality of life.
Impact:
- Provides valuable long-term data on ureterosigmoidostomy, serving as a benchmark for comparing newer urinary diversion techniques.
- Highlights the importance of careful follow-up to optimize functional results and patient well-being after ureterosigmoidostomy.
Abstract:
In 65 patients (pts) (130 renal units) with invasive bladder cancer treated at our institution from 1971 to 1992, ureterosigmoidostomy was performed. Early complications (< 3 month) occurred in 25 patients: 9 pts had a pyelonephritis, 3 pts underwent surgery for revision of the ureteral anastomosis because of leakage and 3 had abdominal wall revisions. 4 pts had a severe hyperchloremic metabolic acidosis, 2 pts had respiratory problems. Late complications observed were: 12 pts with pyelonephritis, 4 pts with ureteral stenosis and 9 pts with hyperchloremic metabolic acidosis. 5 patients were incontinent and 3 pts had a anastomotic colon cancer after 10, 12 and 17 years respectively. In 26/65 (40%) of patients with survival over 5 years continence and quality of life were evaluated by means of a questionnaire. 23/26 pts (88%) were continent during daytime and complete continence during the night was reported by 14/26 pts (54%). Quality of life was assessed in a global manner (family and social life, sexuality, comfort, travel and sport) and was rated as satisfactory in 24/26 pts (92%). 2 pts were unsatisfied due to diarrhea. In conclusion, good long-term functional results can be obtained with ureterosigmoidostomy with a careful follow-up. Our long-term results may serve as a basis for comparison with other more recently developed continent urinary diversions such as low pressure systems.