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A new modification of tubeless cutaneous ureterostomy following radical cystectomy

  • Arman TsaturyanEmail author
  • Serine Sahakyan
  • Armen Muradyan
  • Sergey Fanarjyan
  • Ashot Tsaturyan
Urology - Original Paper
  • 17 Downloads

Abstract

Purpose

Cutaneous ureterostomy is a well-established surgical technique of incontinent urinary diversion treatment. However, stoma stenosis limits widespread utilization of this technique. We present our modification of constructing single-site tubeless cutaneous ureterostomy aiming to reduce stomal complications and improve catheter-free rate of those patients.

Materials and methods

In 2016–2017, 30 patients with 60 renal units underwent modified and 30 patients with 60 renal units standard technique. The main differences of our method from previously described techniques were the preservation of parietal peritoneum and fixation of ureteral orifices one to another. Catheter-free rate was calculated in all patients with a minimum follow-up period of 12 months. In total, 52 patients, 26 from the modified cutaneous ureterostomy group, and 26 from the standard cutaneous ureterostomy group were available for the final analysis.

Results

The patients’ mean age was 63.1 years. The median follow-up period was 25.8 months (ranging from 1–37 months). The catheter-free rate was achieved 76.9% (20 patients) in the modified group compared to 42.3% (11 patients) in the standard group (P value = 0.013). No statistically significant differences were observed between two groups for late complications and readmission rates.

Conclusions

Our technique of single-site-modified cutaneous ureterostomy is a safe and simple surgical technique with similar postoperative complications rate and better catheter-free rate compared to standard cutaneous ureterostomy. We believe that this technique could be a method of choice not only for candidates for cutaneous ureterostomy but also for selected patients for ileal conduit.

Keywords

Cutaneous ureterostomy Radical cystectomy Urinary diversion Ureteroureterostomy Ileal conduit 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E386.  https://doi.org/10.1002/ijc.29210 Google Scholar
  2. 2.
    Witjes JA, Comperat E, Cowan NC, De Santis M, Gakis G, Lebret T, Ribal MJ, Van der Heijden AG, Sherif A, European Association of U (2014) EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 65(4):778–792.  https://doi.org/10.1016/j.eururo.2013.11.046 Google Scholar
  3. 3.
    Farnham SB, Cookson MS (2004) Surgical complications of urinary diversion. World J Urol 22(3):157–167.  https://doi.org/10.1007/s00345-004-0429-5 Google Scholar
  4. 4.
    Hautmann RE (2003) Urinary diversion: ileal conduit to neobladder. J Urol 169(3):834–842.  https://doi.org/10.1097/01.ju.0000029010.97686.eb Google Scholar
  5. 5.
    Novotny V, Zastrow S, Koch R, Wirth MP (2012) Radical cystectomy in patients over 70 years of age: impact of comorbidity on perioperative morbidity and mortality. World J Urol 30(6):769–776.  https://doi.org/10.1007/s00345-011-0782-0 Google Scholar
  6. 6.
    Studer UE, Burkhard FC, Schumacher M, Kessler TM, Thoeny H, Fleischmann A, Thalmann GN (2006) Twenty years experience with an ileal orthotopic low pressure bladder substitute—lessons to be learned. J Urol 176(1):161–166.  https://doi.org/10.1016/S0022-5347(06)00573-8 Google Scholar
  7. 7.
    Rodriguez AR, Lockhart A, King J, Wiegand L, Carrion R, Ordorica R, Lockhart J (2011) Cutaneous ureterostomy technique for adults and effects of ureteral stenting: an alternative to the ileal conduit. J Urol 186(5):1939–1943.  https://doi.org/10.1016/j.juro.2011.07.032 Google Scholar
  8. 8.
    Longo N, Imbimbo C, Fusco F, Ficarra V, Mangiapia F, Di Lorenzo G, Creta M, Imperatore V, Mirone V (2016) Complications and quality of life in elderly patients with several comorbidities undergoing cutaneous ureterostomy with single stoma or ileal conduit after radical cystectomy. BJU Int 118(4):521–526.  https://doi.org/10.1111/bju.13462 Google Scholar
  9. 9.
    Deliveliotis C, Papatsoris A, Chrisofos M, Dellis A, Liakouras C, Skolarikos A (2005) Urinary diversion in high-risk elderly patients: modified cutaneous ureterostomy or ileal conduit? Urology 66(2):299–304.  https://doi.org/10.1016/j.urology.2005.03.031 Google Scholar
  10. 10.
    Lee RK, Abol-Enein H, Artibani W, Bochner B, Dalbagni G, Daneshmand S, Fradet Y, Hautmann RE, Lee CT, Lerner SP, Pycha A, Sievert KD, Stenzl A, Thalmann G, Shariat SF (2014) Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int 113(1):11–23.  https://doi.org/10.1111/bju.12121 Google Scholar
  11. 11.
    Kim CJ, Wakabayashi Y, Sakano Y, Johnin K, Yoshiki T, Okada Y (2005) Simple technique for improving tubeless cutaneous ureterostomy. Urology 65(6):1221–1225.  https://doi.org/10.1016/j.urology.2004.12.009 Google Scholar
  12. 12.
    Terai A, Yoshimura K, Ueda N, Utsunomiya N, Kohei N, Arai Y (2006) Clinical outcome of tubeless cutaneous ureterostomy by the Toyoda method. Int J Urol 13(7):891–895.  https://doi.org/10.1111/j.1442-2042.2006.01435.x Google Scholar
  13. 13.
    Wada Y, Kikuchi K, Imamura T, Suenaga T, Matsumoto K, Kodama K (2008) Modified technique for improving tubeless cutaneous ureterostomy by Ariyoshi method. Int J Urol 15(2):144–150.  https://doi.org/10.1111/j.1442-2042.2007.01948.x (discussion 150) Google Scholar
  14. 14.
    Ariyoshi A, Fusijawa Y, Ohshima K, Hiratsuka Y, Sakamoto K (1975) Catheterless cutaneous ureterostomy. J Urol 114(4):533–535Google Scholar
  15. 15.
    Kearney GP, Docimo SG, Doyle CJ, Mahoney EM (1992) Cutaneous ureterostomy in adults. Urology 40(1):1–6Google Scholar
  16. 16.
    MacGregor PS, Montie JE, Straffon RA (1987) Cutaneous ureterostomy as palliative diversion in adults with malignancy. Urology 30(1):31–34Google Scholar
  17. 17.
    Toyoda Y (1977) A new technique for catheterless cutaneous ureterostomy. J Urol 117(3):276–278Google Scholar
  18. 18.
    Jilling A, Frang D (1986) Cutaneous ureterostomy with an introverted pediculate skin flap. Int Urol Nephrol 18(2):153–158Google Scholar
  19. 19.
    Chitale SV, Chitale VR (2006) Bilateral ureterocutaneostomy with modified stoma: long-term follow-up. World J Urol 24(2):220–223.  https://doi.org/10.1007/s00345-006-0080-4 Google Scholar
  20. 20.
    Namiki T, Yanagi S (1995) A new technique for bilateral single stoma loop cutaneous ureterostomy. J Urol 154(2 Pt 1):361–363Google Scholar
  21. 21.
    Lodde M, Pycha A, Palermo S, Comploj E, Hohenfellner R (2005) Uretero-ureterocutaneostomy (wrapped by omentum). BJU Int 95(3):371–373.  https://doi.org/10.1111/j.1464-410X.2005.05302.x Google Scholar
  22. 22.
    Zhang S, Gao F, Xue C, Zhang N, Gao F, Li S, Wen J (2017) The application of wrapping ureter by a pedicled gastrocolic omentum flap combined with an artificial external scaffold to prevent stoma stenosis in rabbit after ureterocutaneostomy. Int Urol Nephrol 49(2):255–261.  https://doi.org/10.1007/s11255-016-1475-9 Google Scholar
  23. 23.
    Huang JH, Lu JY, Yao XD, Peng B, Wang GC, Zheng JH (2015) Comparison of two kinds of cutaneous ureterostomy using in radical cystectomy. Int J Clin Exp Med 8(8):14371–14375Google Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of UrologyYerevan State Medical UniversityYerevanArmenia
  2. 2.Department of Urology“Artmed” Medical CenterYerevanArmenia
  3. 3.Turpanjian School of Public HealthAmerican University of ArmeniaYerevanArmenia

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