Pyelotransverse Pyelocolostomy: An Alternative Method for High Urinary Diversion in Patients with Extended Bilateral Ureter Damage

Abstract

After previous radiation due to pelvic malignoma or after multiple operations, the ileal conduit as well as sigmoid conduit are associated with an increased rate of complications. In these patients, the middle and distal ureter often cannot be considered for reimplantation due to fibrosis. High anastomosis to a bowel segment which is undamaged proves favorable. The transverse colon, conveniently situated in the cranial abdomen, is close enough to the kidneys for such a high anastomosis and is mostly spared from irradiation. In cases where severely damaged ureters forbid connection to a normal transverse conduit, we performed a pyelotransverse pyelocolostomy with high anastomosis of the bowel to both renal pelves or ureteropelvic junctions. 7 patients have been treated in this way and the follow-up of these patients ranges between 14 and 24 months. Postoperatively increased renal function was found in 6 renal units, stable function in 6 renal units, and only 1 patient showed a functional ureteropelvic stenosis. 4 months after the operation 1 patient died of sepsis caused by recurrent urinary tract infections due to recurrent stone disease as a consequence of immobilization in myelomeningocele. In patients with nearly total loss of ureters the pyelotransverse conduit is an effective surgical solution and may prove more comfortable to the patient than bilateral percutaneous nephrostomies.