You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20111146 CUTANEOUS URETEROSTOMY TECHNIQUE FOR ADULTS AND EFFECTS OF URETERAL STENTING: AN ALTERNATIVE TO THE ILEAL CONDUIT Alejandro R. Rodriguez, Alexandre Lockhart, Jeff King, Lucas Wiegand, Rafael Carrion, Raul Ordorica, and Jorge Lockhart Alejandro R. RodriguezAlejandro R. Rodriguez Tampa, FL More articles by this author , Alexandre LockhartAlexandre Lockhart Tampa, FL More articles by this author , Jeff KingJeff King Tampa, FL More articles by this author , Lucas WiegandLucas Wiegand Tampa, FL More articles by this author , Rafael CarrionRafael Carrion Tampa, FL More articles by this author , Raul OrdoricaRaul Ordorica Tampa, FL More articles by this author , and Jorge LockhartJorge Lockhart Tampa, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.745AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cutaneous ureterostomies (CU) have been an accepted modality for urinary diversion (UD) in children. The procedure has been done sparingly in adults due to surgeons' concern of obstruction. We present surgical technical modifications that have improved the outcomes of this type of urinary diversion. METHODS 310 patients with a median age of 71 years (38–88), received CU as a UD procedure. Median follow-up was 756 days (30–5229). The technique included: a) Mobilization of the left ureter and descending colon; b)Transposition of the left ureter above the IMA to the right hemi abdomen; c) Mobilization of the ileocecal segment with repositioning above both terminal ureters; d) Fixation of the abdominal wall hiatus with four angles sutures; e) Spatulation and Y V plasty of the ureters with edge to edge anastomosis for stoma creation. The first 161 patients (Group A, 59.1%) had the JJ stents removed in the immediate postoperative period. The second group of 111 patients (Group B, 40.8%), kept the stents longer (>3 months). Patients were followed with abdominal CT's and sometimes with lasix renography for evaluation of ureteral function and excretion, in addition to the necessary studies for their primary disease follow-up. The model used for analysis was binary logistic regression, which individually compared the binary response of left (L), right (R) and bilateral (B) renal obstruction, with the time patients had stent involvement. RESULTS 272 patients were available for follow-up. Ureteral obstructions occurred in 36 (13.2%). Fifty-five patients had received preoperative radiation. In the overall group, obstruction occurred on the right (R) in 6 patients (2.2%), on the left (L) in 29 patients (9.9%) and bilaterally (B) in 3 individuals (1.1%). Obstruction was treated with re-stenting in 20 pts (55.4%), stoma revision in 12 pts (33.3%) or conversion to conduit in 4 (11%). Ureteral obstruction occurred in Group A: R (3.7%), L (13.7%), and Bilateral (1.82%). In Group B: R (0%), L (4.5%), and Bilateral (0%). Length of stent placement did not affect obstruction on the right ureter. However, stenting time had an impact on the left ureter, with less obstruction in group B (> 3 months). (p=.01). CONCLUSIONS As in other types of urinary diversions, obstruction of the left ureter is a common complication of bilateral cutaneous ureterostomies. In our experience, long term stenting (>3 months) as well as the surgical modifications applied, improved the clinical outcome of this type of urinary diversion in adults, achieving similar results that are comparable to the ileal conduit. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e460 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alejandro R. Rodriguez Tampa, FL More articles by this author Alexandre Lockhart Tampa, FL More articles by this author Jeff King Tampa, FL More articles by this author Lucas Wiegand Tampa, FL More articles by this author Rafael Carrion Tampa, FL More articles by this author Raul Ordorica Tampa, FL More articles by this author Jorge Lockhart Tampa, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...