Staged ureterocolocolostomy urinary diversion.

Disappointing long-term experience with the ureterosigmoidostomy and ileal loop diversion has prompted our use of a staged ureterocolocolostomy in 3 adults with a good prognosis. Creation of a non-refluxing colon conduit was followed by conduit take-down and end-to-side colocolostomy 4 to 8 months later, when satisfactory loop function was documented (that is absence of reflux, obstruction and infection). Followup has shown stable renal function and electrolyte balance, as well as urinary/fecal continence. The staged ureterocolocolostomy, as opposed to the primary ureterosigmoidostomy, allows the partially obstructed urinary tract to decompress isolated from the fecal stream, may be used with established pyelonephritis, permits confirmation of the non-refluxing nature of the ureterocolic anastomosis prior to colocolostomy and may have a lower incidence of electrolyte imbalance. The staged procedure is contraindicated in patients with a poor prognosis, previously irradiated rectosigmoid, fecal incontinence or poor anal sphincter tone, inflammatory large bowel disease, inadequate ureteral length and strong family history of colon cancer.