Cutaneous Ureterostomy Technique for Adults and Effects of Ureteral Stenting: An Alternative to the Ileal Conduit

Rodríguez, Alejandro; Lockhart, Alexandre; King, Jeff; Wiegand, Lucas; Carrión, Rafael; Ordorica, Raul; Lockhart, Jorge L.

doi:10.1016/j.juro.2011.07.032

Cited by 41 publications

(25 citation statements)

References 23 publications

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“…In another study, parastomal hernia was observed in 4 of 272 patients (1.5%) who were treated by CU [10]. To decrease the frequency of stomal stenosis, we constructed a larger abdominal tunnel for the ureters than that described in the general procedure for the CU [7].…”

Section: Discussionmentioning

confidence: 99%

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Evaluations for Hydronephrosis After the Establishment of Tubeless Cutaneous Ureterostomy

2013

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PurposeTo investigate hydronephrosis after the establishment of tubeless cutaneous ureterostomy by using our definition of the tubeless condition and our indications for catheter insertion.Materials and MethodsTwenty-eight (54 renal units) patients with both establishment of tubeless cutaneous ureterostomy 3 months after surgery and at least 12 months of follow-up were investigated in this study. The 4-grade system was used to evaluate the hydronephrosis. The definition of the tubeless condition in cutaneous ureterostomy was as follows: 1) the catheter stent is not placed in the renal pelvis through the stoma, 2) the grade of hydronephrosis is less than 3, and 3) the kidney is functioning. Indications for catheter insertion after the establishment of tubeless cutaneous ureterostomy were as follows: 1) difficulty in curing acute pyelonephritis by drug treatments, 2) flank pain due to hydronephrosis, or 3) increase in the grade of hydronephrosis.ResultsThe follow-up period was 12 to 78 months (average, 40.5±22.1 months). After the establishment of tubeless cutaneous ureterostomy, 6 of 54 renal units (11.1%) were eligible for catheter insertion. The catheter insertion was performed in 4 renal units. Another 2 renal units were followed up without intervention, and they gradually became atrophic. The renal functions were preserved in the other 52 renal units.ConclusionsOur results suggest that our definition of the tubeless condition and our indications for catheter insertion would be useful for the evaluation and management of hydronephrosis after establishment of tubeless cutaneous ureterostomy.

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Section: Discussionmentioning

confidence: 99%

“…After the surgery, a 6-Fr single-J stent was placed in the renal pelvis through the stoma. In all cases, the single-J stents were exchanged every 4 weeks and were removed 3 months after the surgery, because the stomal conditions were unstable and obstructive in the early phases after the surgery [9,10]. …”

Section: Methodsmentioning

confidence: 99%

Evaluations for Hydronephrosis After the Establishment of Tubeless Cutaneous Ureterostomy

2013

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“…After surgery, a 6-Fr single-J stent was placed in the renal pelvis through the stoma in all patients. In all cases, the single-J stents were exchanged every 4 weeks and were removed 3 months after surgery, because the stomal conditions were unstable and obstructive in the early phase after surgery [10,12]. Stomal conditions were evaluated with excretory urography at 3 and 6 months after the surgery and with MAG3 diuretic renography at 3 months after the surgery.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Criteria for Stomal Obstruction of Tubeless Cutaneous Ureterostomy by Use of^99mTc-Mercaptoacetyltriglycine Diuretic Renography

2013

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PurposeTo evaluate 99mTc-mercaptoacetyltriglycine diuretic renograms for diagnosing stomal obstruction in tubeless cutaneous ureterostomy.Materials and MethodsCutaneous ureterostomy was performed in 29 patients (56 renal units) with a minimum follow-up period of 12 months. Stomal obstruction was evaluated with 99mTc-mercaptoacetyltriglycine diuretic renography 3 months after surgery. Regions of interest were drawn that completely encircled and snugly fit the kidney, renal pelvis, and ureter. The data analyses were performed with half-times to tracer clearance following furosemide (0.5 mg/kg) administration.ResultsThe mean half-times to tracer clearance were 6.90±6.30, 5.25±4.29, and 8.75±7.63 minutes in the total, ipsilateral, and contralateral kidneys, respectively, in side relationships between the ureter and the stoma. There were significant differences between the ipsilateral and contralateral kidneys in the mean half-time to tracer clearance (p=0.038). Forty-eight renal units (85.7%) had a half-time to tracer clearance of less than 15 minutes, and all 48 renal units had no hydronephrosis. On the other hand, 5 renal units (8.9%) had a half-time to tracer clearance of more than 20 minutes, and these 5 renal units required the insertion of stent catheters or became atrophic.Conclusions99mTc-mercaptoacetyltriglycine diuretic renography was very useful for diagnosing stomal obstruction of tubeless cutaneous ureterostomy. The upper limit of the half-time to tracer clearance for unobstructed systems was 15 minutes, which allowed for the confident exclusion of stomal obstruction in tubeless cutaneous ureterostomy.

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“…Paradossalmente sembrerebbero essere migliori i risultati di due tipi di derivazioni urinarie ormai da tempo "demo-nizzate": l'ureterocutaneostomia e l'ureterosigmoidostomia. Il lavoro del gruppo urologico di Tampa in Florida e pubblicato a Novembre del 2011, ad esempio, analizza i risultati di 272 pazienti sottoposti a cistectomia ed ureterocutaneostomia: 13% di stenosi ureterali, 3% di stenosi dello stoma e 14% di pielonefriti (8). Nel lavoro di Frank e collaboratori (Mayo Clinic) pubblicato nel 2009, vengono presi in considerazione i dati di 245 pazienti sottoposti a cistectomia radicale ed ureterosigmoidostomia dal 1956 al 2006, con particolare attenzione a 51 pazienti con followup superiore ai 10 anni; è possibile apprezzare un 22% di stenosi dell'anastomosi uretero-sigmoidea, 16% di pielonefriti ricorrenti, 10% di calcolosi, acidosi metabolica nel 4% dei casi, continenza totale nel 92% dei casi: risultati funzionali quindi eccellenti e complicanze confrontabili con gli altri tipi di derivazioni urinarie (9).…”

Section: Congresso Sun -Roma 2011unclassified

Urinary Diversions and Bladder Replacement Surgery: Evolution, Current Situation and Long-Term Outcomes

2012

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Nowadays, radical cystectomy represents the first choice of therapy for muscle invasive bladder cancer. The first choice after radical cystectomy, both in male and in female patients, is no more urinary diversion, but bladder replacement surgery through orthotopic reconstruction. The ileal conduit is considered a safe procedure and the gold standard to which newer forms of urinary diversion should be compared, although few long-term results are known. Currently, neobladder is the most important urinary diversion in the world, followed by Bricker's ileal conduit. We evaluated the long-term results of the most important forms of urinary diversions, analyzing some data available in the Literature. Then, we focused our attention on long-term outcomes of our "Y Neobladder": functional outcome and long-term complications. At last, we critically examined the widely accepted notion that patients undergoing "Y Neobladder" experience superior quality of life outcomes than patients receiving an ileal conduit.

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Cutaneous Ureterostomy Technique for Adults and Effects of Ureteral Stenting: An Alternative to the Ileal Conduit

Abstract: As with other types of urinary diversion, left ureteral obstruction is a common complication of bilateral cutaneous ureterostomies. Long-term stenting for greater than 3 months and the applied surgical modifications improved the clinical outcome of this type of urinary diversion.

Cited by 41 publications

References 23 publications

Evaluations for Hydronephrosis After the Establishment of Tubeless Cutaneous Ureterostomy

Evaluations for Hydronephrosis After the Establishment of Tubeless Cutaneous Ureterostomy

Diagnostic Criteria for Stomal Obstruction of Tubeless Cutaneous Ureterostomy by Use of^99mTc-Mercaptoacetyltriglycine Diuretic Renography

Urinary Diversions and Bladder Replacement Surgery: Evolution, Current Situation and Long-Term Outcomes

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Cutaneous Ureterostomy Technique for Adults and Effects of Ureteral Stenting: An Alternative to the Ileal Conduit

Abstract: As with other types of urinary diversion, left ureteral obstruction is a common complication of bilateral cutaneous ureterostomies. Long-term stenting for greater than 3 months and the applied surgical modifications improved the clinical outcome of this type of urinary diversion.

Cited by 41 publications

References 23 publications

Evaluations for Hydronephrosis After the Establishment of Tubeless Cutaneous Ureterostomy

Evaluations for Hydronephrosis After the Establishment of Tubeless Cutaneous Ureterostomy

Diagnostic Criteria for Stomal Obstruction of Tubeless Cutaneous Ureterostomy by Use of99mTc-Mercaptoacetyltriglycine Diuretic Renography

Urinary Diversions and Bladder Replacement Surgery: Evolution, Current Situation and Long-Term Outcomes

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Diagnostic Criteria for Stomal Obstruction of Tubeless Cutaneous Ureterostomy by Use of^99mTc-Mercaptoacetyltriglycine Diuretic Renography