Papadimitriou Christos, Deliveliotis Charalampos, Dellis Athanasios, Martin Wilfried, Mitsogiannis Iraklis
Department of Urology, St. Antonius Hospital Gronau, Gronau, DEU.
2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, GRC.
Cureus. 2022 Jul 31;14(7):e27501. doi: 10.7759/cureus.27501. eCollection 2022 Jul.
Introduction Uretero-ureterostomy combined with unilateral nephrostomy is a rarely performed urinary diversion following radical cystectomy for muscle-invasive bladder cancer. The aim of this study is to assess the efficacy and safety of the procedure. Materials and methods Patients with muscle-invasive bladder cancer and poor performance status were enrolled in this retrospective, observational, single-centre study, carried out between December 2018 and November 2020. The patient's renal function was regularly assessed with serum creatinine and estimated glomerular filtration rate (eGFR). Evaluation of peri- and postoperative complications was performed based on clinical, laboratory, endoscopic, ultrasound and other radiological studies findings. The patient's status was assessed for 12 months. Results Thirty-six patients with a mean age of 77.4±8.6 years were enrolled in the study. 86.11% of patients had an American Society of Anesthesiologists Score ≥3 and 91.66% had an age-adjusted Charlson comorbidity index of ≥6. Slight deterioration of renal function, although not statistically significant, was observed. 36.11% of the patients developed permanent unilateral pelvic dilatation. Acute pyelonephritis, urosepsis, pyonephrosis and anastomotic leak were observed in 22.22%, 8.33%, 5.55% and 5.55% of patients, respectively; all were treated either conservatively and/or with minimally invasive procedures (nephrostomy, JJ-stent insertion) without any need for open surgical revision. Conclusions Ureteroureterostomy combined with unilateral nephrostomy is a safe and effective method of urinary diversion following radical cystectomy for muscle-invasive bladder cancer with easily manageable complications.
引言 输尿管-输尿管吻合术联合单侧肾造瘘术是根治性膀胱切除术后用于肌层浸润性膀胱癌的一种很少实施的尿流改道术。本研究的目的是评估该手术的疗效和安全性。
材料与方法 本回顾性、观察性、单中心研究纳入了2018年12月至2020年11月期间肌层浸润性膀胱癌且身体状况较差的患者。定期通过血清肌酐和估算肾小球滤过率（eGFR）评估患者的肾功能。根据临床、实验室、内镜、超声及其他影像学检查结果对围手术期和术后并发症进行评估。对患者的状况进行了12个月的评估。
结果 36例患者纳入研究，平均年龄为77.4±8.6岁。86.11%的患者美国麻醉医师协会（ASA）评分≥3，91.66%的患者年龄校正Charlson合并症指数≥6。观察到肾功能有轻微恶化，尽管无统计学意义。36.11%的患者出现永久性单侧肾盂扩张。分别有22.22%、8.33%、5.55%和5.55%的患者发生急性肾盂肾炎、尿脓毒症、肾积脓和吻合口漏；所有这些均采用保守治疗和/或微创手术（肾造瘘术、置入输尿管支架）进行治疗，无需进行开放手术修复。
结论 输尿管-输尿管吻合术联合单侧肾造瘘术是根治性膀胱切除术后用于肌层浸润性膀胱癌的一种安全有效的尿流改道术，并发症易于处理。
