Thakker Parth Udayan, Refugia Justin Manuel, Casals Randy, Able Corey, Tsivian Matvey
Department of Urology, Atrium Health Wake Forest Baptist, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Int Urol Nephrol. 2023 Nov;55(11):2809-2814. doi: 10.1007/s11255-023-03721-y. Epub 2023 Aug 2.
Cutaneous ureterostomy (CU) urinary diversion after radical cystectomy has been relegated to highly comorbid patients due to presumed rates of stenosis and drainage tube dependence. Rates of stricture as high as 70% have been reported. Though a variety of techniques have been developed to obviate the need for prolonged stenting, CU remains uncommonly performed. Herein, we present our experience with CU diversion after radical cystectomy and stent-free rates post-operatively.
We retrospectively reviewed the records of consecutive patients undergoing radical cystectomy with single-stoma cutaneous ureterostomy from June 2020 to December 2022 at our institution. Demographic and clinical data were summarized. We recorded the presence of ureteral stent, nephrostomy, or nephroureteral catheter at the last follow-up. The primary outcome was "stent-free survival" incorporating all modalities of tube-dependent urinary drainage. Kaplan-Meier analysis was performed to determine stent-free survival at 12 months.
We identified 28 patients meeting inclusion criteria with median age of 73 years (IQR: 66-78) and median body mass index of 25 (IQR: 22-28). Of patients that underwent stent-free trial (N = 23), the stent-free survival at 12 months was 74%. Five of 28 patients had continued tube dependence due to locally advanced disease with hydronephrosis rather than CU stenosis. These results suggest that single-stoma CU should be considered a viable option for patients undergoing radical cystectomy. Longer follow-up is needed to assess durability of stent-free rates.
根治性膀胱切除术后的皮肤输尿管造口术（CU）尿流改道术由于推测的狭窄率和对引流管的依赖，已被用于合并症严重的患者。据报道，狭窄率高达70%。尽管已开发出多种技术以避免长期置管的需要，但CU仍不常施行。在此，我们介绍我们在根治性膀胱切除术后行CU尿流改道术的经验以及术后无支架率。
我们回顾性分析了2020年6月至2022年12月在我院接受根治性膀胱切除术并单口皮肤输尿管造口术的连续患者的记录。总结了人口统计学和临床数据。我们记录了最后一次随访时输尿管支架、肾造瘘管或肾输尿管导管的情况。主要结局是“无支架生存”，包括所有依赖引流管的尿液引流方式。进行Kaplan-Meier分析以确定12个月时的无支架生存率。
我们确定了28例符合纳入标准的患者，中位年龄为73岁（四分位间距：66 - 78岁），中位体重指数为25（四分位间距：22 - 28）。在接受无支架试验的患者（n = 23）中，12个月时的无支架生存率为74%。28例患者中有5例因局部晚期疾病伴肾积水而非CU狭窄而持续依赖引流管。这些结果表明，单口CU应被视为根治性膀胱切除术患者的一种可行选择。需要更长时间的随访来评估无支架率的持久性。
