The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
SINGLE-STOMAL URETEROSTOMY BY EXTRAPERITONEAL APPROACH
Ichiro SatakeKiyonobu TariKouji ChibaKazuaki NakagomiKazunori OzawaToshihiko Tsujii
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1995 Volume 86 Issue 5 Pages 1028-1033

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Abstract

Single-stomal ureterostomy such as double barreled ureterocutaneostomy and cutaneous transureteroureterostomy have usually been performed by transperitioneal approach. However, extraperitoneal method is preferable since the patients for whom ureterocutaneostomy is indicated usually have a deteriorating general condition. We have reported single-stomal ureterocutaneostomy which can be done extraperitoneally.
A total of thirteen patients, one man and twelve women, for whom permanent urinary diversion was indicated, have undergone this extraperitoneal ureterocutaneostomy for February 1988 to June 1994. Those with retroperitoneal lesions or with a history of paraaortic radiotherapy were excluded. The mean age was 61.7 (range: 42-76). The reasons for urinary diversion were vesicovaginal fistula in seven, obstructive nephropathy in four, rectovesical fistula in one and postoperative urine leak from the bladder in one. All patients had been treated for malignant diseases and had undergone transperitoneal surgery. Six patients had colostomy and ten had clinically evident recurrent diseases.
In the operation, left ureter was dissected and severed extraperitoneally through left paramedian incision or left lumbotomy. The ureteral end was pushed to the right in a retroperitoneal tunnel created by blunt dissection. Then the ureter was picked up through the contralateral retroperitoneal approach. After both ureters were exposed, ureterocutaneostomy was made in right hypogastrium. Transureteroureterstomy with end-cutaneous ureterostomy, double barreled ureterocutaneostomy and ureteroureterostomy with loop ureterostomy were done in six, four and three patients, respectively. The mean operative time was 119 (range: 75-175) minutes and the mean intraoperative blood loss was 210 (range: 48-682) grams. Arrhythmia developed during retroperitoneal manipulation in one patient for whom the operation was done under spinal anesthesia. Retroperitoneal hemorrhage was seen in another one. Postoperative urine leak and late stomal trouble were seen in one and three patients, respectively. No other complications associated with the operative procedure were observed with follow-up periods of 1-19 months. Food intake was commenced within four operative days in nine of the patients.
This extraperitoneal ureterocutaneostomy we have reported have two disadvantages: First, two separate incisions are necessary. Second, it is sometimes difficult to form a retroperitoneal tunnel through which a ureter is pushed toward the opposite side. In spite of these, this method enables without opening peritoneum the single-stomal ureterostomy which is highly advantageous in terms of quality of life over bilateral ureterostomy. In conclusion, we believe that this method of ureterocutaneostomy is worthwhile for those who have an expected survival of three months or more and have intraabdominal lesions or a history of abdominal surgery.

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© Japanese Urological Association
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