Bilateral ureterocutaneostomy with modified stoma: long-term follow-up

Abstract

Ileal conduit and orthotopic bladder substitution have been the preferred options for urinary diversion after cystectomy. Self-catheterisation has revolutionised the management of neuropathic bladder. However, ureterocutaneostomy (cutaneous ureterostomy) described as a means of supravesical urinary diversion 40 years ago still has a definite role for both temporary and permanent diversion particularly in the developing countries. We present a small series of cutaneous ureterostomies performed in four children who have now grown up to become adults without being undiverted. We discuss the technique that we used to modify the stoma, which helped prevent stomal complications over the long term. Our results we believe will rekindle the interest in cutaneous ureterostomy as a viable option for permanent urinary diversion. Four children between ages 2 and 16 years had bilateral side-to-side single stoma tubeless end cutaneous ureterostomy as a primary procedure for permanent urinary diversion. The stoma was modified to prevent retraction and stenosis. Long-term follow-up is presented. All the children have grown up to become adults with their ureterocutaneostomies functioning very well. There have been no biochemical or mechanical complications. Only one out of four stomas had to be refashioned. A simple collection device has proved successful in maintaining a watertight drainage system without apparent problems. Bilateral side-to-side single stoma end cutaneous ureterostomy with modification of the stoma by a plastic surgical technique can help achieve a non-retracting stoma on which a collection device can snuggly fit. It is a viable option for permanent urinary diversion without any significant complications. It is simple, easy and highly practical way of managing urinary diversion especially in the developing countries.