[Ureterosigmoidostomy and transcolonic cutaneous ureterostomy. Technical indications and results].

Experience with transcolonic Ureterosigmoidostomy (US) in 127 patients and colonic conduit (CC) in 152 patients is presented in detail. US proved to be highly satisfactory in children, in particular in bladder exstrophy (13% post-operative and 27% late complications, deterioration in 8% of all renal units), but gave poor results in adults. This was mainly due to the patient selection, as in this group preoperative damage to the upper urinary tract by pyelonephritis, obstruction, irradiation or previous surgery was frequent. Obviously these factors prohibit US. For the same reason US excludes adjunctive radiotherapy in cancer patients. Although employed in a higher renal risk group (signs of pyelonephritis in 34% and ureteral dilatation in 54% of the renal units in the preoperative IVP) CC with non-refluxing uretero-intestinal anastomoses reliably stabilized renal morphology (improvement of ureteral dilatation in 79%, over all deterioration 10% of all kidneys, mainly by progression of pyelonephritis established already before diversion). The low late complication rates of 21% in children and 31% in adults (with benign disease) compare favourably with the results reported in comparable series of ileal conduits.