Department of Urology, Yerevan State Medical University, Yerevan, Armenia.
Department of Urology, "Artmed" Medical Center, Yerevan, Armenia.
Int Urol Nephrol. 2019 Jun;51(6):959-967. doi: 10.1007/s11255-019-02145-x. Epub 2019 Apr 13.
Cutaneous ureterostomy is a well-established surgical technique of incontinent urinary diversion treatment. However, stoma stenosis limits widespread utilization of this technique. We present our modification of constructing single-site tubeless cutaneous ureterostomy aiming to reduce stomal complications and improve catheter-free rate of those patients.
In 2016-2017, 30 patients with 60 renal units underwent modified and 30 patients with 60 renal units standard technique. The main differences of our method from previously described techniques were the preservation of parietal peritoneum and fixation of ureteral orifices one to another. Catheter-free rate was calculated in all patients with a minimum follow-up period of 12 months. In total, 52 patients, 26 from the modified cutaneous ureterostomy group, and 26 from the standard cutaneous ureterostomy group were available for the final analysis.
The patients' mean age was 63.1 years. The median follow-up period was 25.8 months (ranging from 1-37 months). The catheter-free rate was achieved 76.9% (20 patients) in the modified group compared to 42.3% (11 patients) in the standard group (P value = 0.013). No statistically significant differences were observed between two groups for late complications and readmission rates.
Our technique of single-site-modified cutaneous ureterostomy is a safe and simple surgical technique with similar postoperative complications rate and better catheter-free rate compared to standard cutaneous ureterostomy. We believe that this technique could be a method of choice not only for candidates for cutaneous ureterostomy but also for selected patients for ileal conduit.
皮输尿管造口术是一种成熟的不可控性尿流改道术，然而，造口狭窄限制了该技术的广泛应用。我们介绍了一种改良的单部位无管皮输尿管造口术，旨在减少造口并发症并提高患者的无管率。
2016 年至 2017 年，30 例 60 个肾脏单位的患者接受了改良技术，30 例 60 个肾脏单位的患者接受了标准技术。与之前描述的技术相比，我们的方法的主要区别在于保留壁层腹膜和固定输尿管口彼此相邻。所有患者均计算无管率，随访时间至少为 12 个月。共有 52 例患者，改良皮输尿管造口组 26 例，标准皮输尿管造口组 26 例，最终纳入分析。
患者的平均年龄为 63.1 岁。中位随访时间为 25.8 个月（1-37 个月）。改良组无管率为 76.9%（20 例），标准组为 42.3%（11 例）（P 值=0.013）。两组晚期并发症和再入院率无统计学差异。
我们的单部位改良皮输尿管造口术是一种安全、简单的手术技术，与标准皮输尿管造口术相比，术后并发症发生率相似，但无管率更高。我们认为，该技术不仅适用于皮输尿管造口术的候选者，也适用于选择的回肠导管术患者。
