1986 Volume 77 Issue 2 Pages 268-275
Sixty-two patients underwent catheterless ureterocutaneostomy as the method of urinary diversion at the Department of Urology, Wakayama Medical College in the 11 years from 1972 to 1982. The follow-up period ranged from 4 days to 108 months, median 16 months. The primary pathological condition was bladder cancer in 30 patients, uterine cancer in 22 patients, other pelvic malignancies in 7 patients and benign disease in 3 patients. We used 4 types of ureterocutaneostomy. Transuretero-ureterocutaneostomy was done in 3 cases, bilateral ureterocutaneostomy through a single stoma in 15 cases, bilateral ureterocutaneostomy with two stomas in 5 and unilateral ureterocutaneostomy for one available kidney in 39 cases.
Stomal stricture developed in 19 cases (31%) which necessitated periodic dilatation, stomal revision or catheter drainage. Eight of these patients required ureteral intubation. Catheterless drainage was maintained in 48 patients. Twenty-one patients (34%) were completely free from stomal trouble, deterioration of renal function and urinary tract infection.
Postoperative complications except for stomal stricture occurred in 38 patients (62%). These complications included wound infection, pyelonephritis, gastrointestinal bleeding and so forth.
Long-term results of ureterocutaneostomy in 9 cases were compared to those of ileal conduit urinary diversion in 24 cases. The urographic deterioration was not seen in the ureterostomy group, while 14.4 percent of renal units deteriorated in the ileal conduit. Pyelonephritis occurred in both groups and it was associated with stomal stricture in the ureterostomy group. Renal calculus developed in the ileal conduit group but not in the ureterostomy group. In ureterocutaneostomy stomal stricture was the only main problem.
Although patients with a dilated and thickened ureter are good candidates for catheterless ureterocutaneostomy, it should be challenged for normal ureter after suitable improvement in the future.
