V1884: CUTANEOUS URETEROSTOMY FOR ADULTS AS AN ALTERNATIVE TO THE ILEAL CONDUIT: VIDEO OF THE SURGICAL TECHNIQUE
VideoIntroduction and Objectives
Here we present a video of the surgical modifications that improved the outcome of cutaneous ureterostomies in adults.
In this video we demonstrate the following modifications: 1. Transposition of the left ureter above the inferior mesenteric artery 2. Mobilization of the ileocecal segment with repositioning above each terminal ureter 3. Abdominal wall hiatus fixation with 4 angle sutures and 4. YV plasty of the ureters with edge-to-edge anastomosis for stomal creation. 161 patients (59.1%) had Double J stents for less than 3 months (Group A) and 111 patients had stents for longer than 3 months (Group B).
Of 272 patients with cutaneous ureterostomies, 36 (13.2%) developed ureteral obstruction. Ureteral obstruction was on the right side in 6 patients (2.2%) and on the left side in 29 (9.9%). Ureteral obstruction was treated with re-stenting in 20 cases (55.4%), stomal revision in 12 (33.3%) and conversion to a conduit in 4 (11%). In Group A, ureteral obstruction developed on the right side, left side, and bilaterally in 3.7%, 13.7%, and 1.82%, respectively. In Group B, ureteral obstruction developed on the right side, left side, and bilaterally in 0%, 4.5%, and 0%, respectively. Stenting time impacted only the left ureter with less obstruction in the group with longer stent placement (greater than 3 months) (p=0.01).
In this video we demonstrate the surgical modifications that have improved the outcomes of cutaneous ureterostomies in adult patients. Long-term stenting for greater than 3 months plays an important role.