A modified cutaneous ureterostomy provides satisfactory short and midterm outcomes in select cases

Özet

Objective: We present the outcomes of modification of cutaneous ureterostomy by extreme lateralization ofthe stoma and use of skin flap for formation of ureterostomy.Material and methods: Between June 2012 and June 2016, 36 patients had modified cutaneous ureterostomy for ureteral obstruction due to pelvic malignancy or genitourinary tuberculosis. Transureteroureterostomy was made with cutaneous stoma at anterior axillary line between iliac crest and lower rib cage, insteadof spinoumbilical line. To prevent stenosis a ʻV’ shaped skin was fed into the stoma. Double J stents wereused in all patients for 6 weeks. Perioperative morbidity and mortality were evaluated. All patients werefollowed up at 3 month intervals.Results: Of 36 patients, 22 had radical cystoprostatectomy (including nephroureterectomy in 2 patients) and7 had palliative cystectomy. Others had locally advanced prostate cancer (n=1), locally advanced cervicalcancer (n=3), ovarian cancer (n=1) and genitourinary tuberculosis with small capacity bladder along witha large vesicovaginal fistula (n=1). One patient developed ureteral necrosis requiring conversion to ilealconduit. Three patients developed stomal stenosis: two were managed by self-dilatation while one requiredrevision of stoma. Thirteen patients died of the disease at a median follow up of 6 months with functioningstoma. Remaining 19 patients survived without any complications at a median follow-up of 20.5 months(5.5-43.5 months). None of the patients had any problem related to ureterostomy bag application.Conclusion: Modified lateral cutaneous ureterostomy provides relatively straighter and shorter retroperitoneal course of ureter with acceptable morbidity and avoids use of bowel in selected patients.