LONG-TERM RESULTS OF TUBELESS CUTANEOUS URETEROSTOMY

Abstract

Forty-six adult patients underwent tubeless cutaneous ureterostomy mainly for advanced intrapelvic malignancies during the 15years since 1969. Construction of nipple stomas was successful in 30 patients (65.2%). Better results were obtained in patients with dilated and non-irradiated ureters. Maintenance of tubeless drainage was possible in 18 patients (60%), while 12 patients (40%) sooner or later required ureteral intubation for stomal stenosis and other reasons. In 7 patients tubeless ureterostomy could be followed for 2 years and 3months to 14years and 8 months with an average of 7 years and 9 months. Urinary drainage and renal function were satisfactory during the period. In 2 patients, however, late obstruction was observed; in one it was caused by gastric cancer metastasis to the ureter 2 years and 3months postoperatively, and in the other stenosis was caused by stomal fibrosis after 10 years of diversion. The results indicate that there are three main changes which affect the stomal patency; 1) atrophy of the ureteral nipple, 2) squamous metaplasia of the ureteral mucosa, and 3) fibrosis of the stoma. Patients with one kidney functioning with a dilated and non-irradiated ureter are good candidates for this kind of operation. However, tubeless cutaneous ureterostomy should be challenged in any of those in whom unilateral ureterostomy is required. Though transureteroureterostomy is a useful procedure in making the stoma single, it should be strictly limited to those in whom construction of a patent stoma is promising.