[Trans-intestinal cutaneous ureterostomy]

Abstract

On the basis of a personal series of 243 cases of transintestinal cutaneous ureterostomy, including 216 cases following total cystectomy, the authors initially review the technical factors determining success, stressing in particular the quality of the uretero-intestinal anastomoses and the careful formation of the parietal tract and the cutaneous stoma. They then analyse their results, defining successively the operative mortality attributable to the diversion (reduced by 2% once the technique has been mastered) the early non-fatal complications (14.8% of intestinal obstructions, only requiring re-operation in 4.5% of cases; 11% of urinary fistula, most of which resolved spontaneously; 8% of faecal fistulae, requiring re-operation in 2/3 of cases; 3.7% of ischaemic necroses of the cutaneous stoma) and finally the late complications affecting the uretero-intestinal anastomoses (17% of stenoses, mostly unilateral), the intestinal graft (0.8% of calculi on non-absorbable sutures: 5.3% of stenoses of the cutaneous stoma; 6% of mucosal prolapses) and the equipment, which has made enormous progress in recent years. Renal function is only preserved when renal failure was not present pre-operatively. The authors conclude on the unquestionable value of transintestinal cutaneous ureterostomy as a high urinary diversion procedure, while recognising that it does not constitute either the ideal solution nor the exclusive solution, particularly after total cystectomy.