A long-term clinical report of a modified unilateral cutaneous ureterostomy in bladder cancer patients receiving radical cystectomy / 中华泌尿外科杂志

Objective:To explore the long-term efficacy of a modified unilateral cutaneous ureterostomy in bladder cancer patients receiving radical cystectomy.Methods:The medical data of 104 bladder cancer patients who underwent ureterostomy in our hospital from Janurary 2013 to December 2020 were retrospectively analyzed. The patients were divided into unilateral and bilateral group. The unilateral group contained 66 cases, with 53 males and 13 females, average age (71.8±9.8) years, body mass index (BMI)(23.3±3.2)kg/m 2. The bilateral group contained 38 cases, with 33 males and 5 females, average age (75.1±10.8) years; BMI (22.7±3.0)kg/m 2. There was no significant difference in the above characteristics between the two groups ( P>0.05). The pathology, survival status, long-term complications between the two groups were compared. Quality of life was assessed during follow-up using the European Core Questionnaire for Quality of Life in Cancer Patients (EORTC QLQ-C30). Results:The unilateral group contained 46(69.7%) muscle invasive bladder cancer (MIBC) cases, 15 (22.7%) cases with lymph node metastasis, 7 (10.6%) cases with distant metastasis. The bilateral group contained 24(63.2%) muscle invasive bladder cancer(MIBC) cases, 6 (15.8%) cases with lymph node metastasis, 2 (5.3%) cases with distant metastasis. There was no significant difference in disease specific survival between the two groups ( P>0.05). During the follow-up, the incidence of overall complication rate in the unilateral group was significantly lower than that in the bilateral group [43.9% (29/66) vs. 63.2% (24/38), P<0.001]. The incidence of pyelonephritis in unilateral group was significantly lower than that in the bilateral group [16.6%(11/66) vs. 42.1%(16/38), P=0.006]. There was no statistical significance in terms of quality of life before operation in the two groups. After operation, both physical function score[(54.9±7.1) vs.(49.2±6.7)] and emotional function score [(63.1±6.4) vs.(59.9±6.7)] in unilateral group were higher than that in bilateral group ( P<0.05). Conclusions:The modified unilateral cutaneous ureterostomy could achieve relatively low complication rate, and improve the quality of life to some extent compared with bilateral ureterostomy.

Ureterostomía cutánea como derivación urinaria definitiva en trasplante renal / Cutaneous ureterostomy as definitive urinary diversion in kidney transplant

Introducción. Cerca del 15 % de los pacientes con insuficiencia renal crónica terminal tienen alteraciones de las vías urinarias inferiores. Estas anomalías eran consideradas una contraindicación para el trasplante renal. Por lo anterior, el objetivo del presente trabajo es describir el comportamiento sociodemográfico y clínico de los pacientes trasplantados renales con ureterostomía cutánea como técnica de derivación definitiva de las vías urinarias. Métodos. Se realizó un estudio descriptivo, longitudinal y retrospectivo de los pacientes trasplantados renales con vejiga anormal y ureterostomía cutánea, entre enero de 1973 y octubre de 2012.Resultados. En 4.294 trasplantes renales, se practicaron 24 (0,55 %) ureterostomías, 19 (79,1 %) como técnica inicial y 5 por falla de la ureteroneocistostomía. Diez (41,7 %) ureterostomías fallaron, la mayoría (8 casos) por estenosis. Se presentó infección urinaria en 20 pacientes y la mortalidad fue del 8,3 % (2/24). El 50 % (12/24) de los pacientes con trasplante de riñón estuvieron libres de infección urinaria durante el primer año. La supervivencia del riñón trasplantado fue de 93,8 % (23/24) a los 18 meses, de 85,9 % (20/24) a los 36 meses y de 66,7 % (16/24) a los 50 meses de seguimiento. La supervivencia de los injertos con ureterostomía sin infección fue del 100 % durante el periodo de seguimiento, mientras que la supervivencia de los riñones con infección urinaria fue de 93 % (23/24) a los 18 meses, de 76 % (18/24) a los 36 meses y de 54 % (13/24) a los 50 meses (p=0,235). Conclusiones. La ureterostomía cutánea es una alternativa segura para la derivación urinaria en pacientes tras-plantados renales con alteraciones de la vejiga que no permite su uso o preparación antes del trasplante

Introduction. About 15% of patients with end-stage chronic renal failure have lower urinary tract abnormalities. These abnormalities were considered a contraindication for kidney transplantation. Therefore, the objective of the present work is to describe the sociodemographic and clinical behavior of renal transplant patients with skin ureterostomy as a definitive urinary tract bypass technique.Methods. A descriptive, longitudinal and retrospective study of renal transplant patients with abnormal bladder and skin ureterostomy was conducted between January 1973 and October 2012.Results. We performed 24 (0.55%) ureterostomies in 4.294 kidney transplants. Nineteen (79.1%) were used as first and definitive urinary diversion, and five were ureteroneocystostomies that failed and required ureterostomy as alternative diversion. Ten (41.7%) ureterostomies failed, most (eight cases) from stenosis. Urinary tract infection (UTI) were present in 20 patients and mortality was 8.3% (2/24); 50% (12/24) of kidney transplants were free of urinary tract infection during the first year. The survival of the transplanted kidney was 93.8% (23/24) at 18 months, 85.9% (20/24) at 36 months, and 66.8% (16/24) at 50 months of follow up. The survival of grafts with ureterostomy without urinary tract infection were 100% during the follow-up period, while the survival of the kidneys with UTI was 93% (23/24) at 18 months, 76% (18/24) at 36 months, and 54% (13/24) at 50 months (p=0.235).Conclusions. Cutaneous ureterostomy is a safe alternative for urinary diversion in transplanted renal patients with bladder abnormalities that cannot be prepared or used for a routine diversion before transplantation

Complicaciones de las derivaciones urinarias heterópicas no continentes: Ureterostomías cutáneas vs conducto ileal / Complications of Non-continent Heteropic Urinary Derivations: Skin Ureterostomies vs Ileal Duct

Introducción Y Objetivos Las derivaciones del tracto urinario abarcan una amplia gama de técnicas quirúrgicas, siendo la causa más frecuente para su uso la patología urotelial maligna. De las derivaciones urinarias no continentes heterótopicas las más utilizadas son el conducto ileal y las ureterostomias cutáneas. La elección de la técnica dependerá de la patología de base, las condiciones del paciente y la experiencia del cirujano. El objetivo de este trabajo es determinar las complicaciones tempranas (≤30 días) y tardías (>30 días) de derivaciones urinarias heterópicas no continentes (DUHNC) tipo conducto ileal (CI) vs ureterostomias cutáneas (UC). Métodos Se realizó un estudio descriptivo retrospectivo de los pacientes llevados a DUHNC tipo CI o UC, desde enero del 2008 a julio del 2016, en un centro de referencia para patología oncológica. Se evaluó: edad, género, comorbilidades, escala de Karnofsky, patología quirúrgica, sangrado, ASA, tiempo quirúrgico, estancia hospitalaria, complicaciones tempranas y tardías. Resultados De los 70 pacientes incluidos, 26 con UC y 44 con CI, prevaleciendo el género masculino en ambos grupos. El promedio de edad fue de 66 y 63 años respectivamente y el indice Karnofsky en todos los pacientes fue superior al 90%. La causa más frecuente fue patología maligna de vejiga. El tiempo quirúrgico fue mayor en los pacientes del CI, siendo estadísticamente significativo (p = 0.000). El sangrado fue similar en ambas técnicas quirúrgicas requiriendo transfusión de hemoderivados el 92,3% de los pacientes con UC y 88,6% de los CI. La estancia hospitalaria no tuvo diferencias. En cuanto a las complicaciones tempranas, la más frecuente en ambos grupos fue el choque hipovolémico (61% UC y 58% CI). De las complicaciones tardías la sepsis urinaria prevaleció en ambos grupos (34% y 18% respectivamente) y la estrechez del estoma y la anastomosis ureteroileal se presentaron en las UC y en los CI respectivamente. La mortalidad en el transoperatorio fue del 12,8%. Conclusiones Las DUHNC como las ureterostomias cutáneas o el conducto ileal son técnicas quirúrgicas con tasas de sangrado, transfusión y estancia hospitalaria similares, pero con una menor proporción de complicaciones tanto tempranas como tardías en los pacientes llevados a conducto ileal

Introduction and Objectives The derivations of the urinary tract cover a wide range of surgical techniques, being the most frequent cause for its use the malignant urothelial pathology. Of the urinary diversions, the heterotopic continents are the ileal conduit and the cutaneous ureterostomies. The choice of technique will depend on the underlying pathology, the patient's conditions and the experience of the surgeon. The aim of this study is to determine the early complications (≤30 days) and late complications (> 30 days) of noncontinental heteropic urinary diversions (NHUD) type ileal conduit (IC) vs cutaneous ureterostomies (CU). Methods A retrospective descriptive study was conducted of patients referred to NHUD type CI or CU, from January 2008 to July 2016, in a referral center for oncological pathology. We evaluated: age, gender, comorbidities, Karnofsky scale, surgical pathology, bleeding, ASA, surgical time, hospital stay, early and late complications. Results Of the 70 patients included, 26 with CU and 44 with IC, the male gender prevailing in both groups. The average age was 66 and 63 years respectively and the Karnofsky index in all patients was over 90%. The most frequent cause was malignant pathology of the bladder. Surgical time was higher in IC patients, being statistically significant (p = 0.000). Bleeding was similar in both surgical techniques requiring transfusion of blood products 92.3% of patients with CU and 88.6% of IC. The hospital stay did not differ. Regarding the early complications, the most frequent in both groups was hypovolemic shock (61% CU and 58% CI). Of the late complications, urinary sepsis prevailed in both groups (34% and 18% respectively) and the narrowing of the stoma and the ureteroileal anastomosis were present in the CU and in the IC, respectively. The mortality in the transoperative period was 12.8%. Conclusions NHUD such as cutaneous ureterostomies or ileal conduit are surgical techniques with similar rates of bleeding, transfusion and hospital stay, but with a lower proportion of complications both early and late in patients taken to the ileal conduit.

Construction and empirical study of self management program for patients with ureteral skin stoma / 中国实用护理杂志

Objective To construct a self management program for patients with ureteral stoma, then validate the proposal. Methods The expert consensus reached an agreement after 2 rounds of Delphi expert consultation of "self management programme", according with the contents of the manual requirements,the intervention patients(41 cases)were given these self management interventions:regular one-on-one ostomy skills training, mental support and motivational interview, recording stoma diary, the control patients were given routine nursing interventions,after 1,3 and 6 months of implementation,their results of self management was evaluated. Results The total score of self-management ability was 99.32±10.41,105.34±13.75,109.18±10.91 in the control group after the intervention of 1,3 and 6 months respectively,and 106.73 ± 13.82,117.65 ± 15.47,129.43 ± 12.37 in the test group,the differences were statistically significant (t=7.847, 9.318, 11.416, P<0.01). The total score of quality of life was 167.18 ± 24.62, 173.36 ± 25.33, 179.48 ± 22.17 in the control group after the intervention of 1, 3 and 6 months respectively,and 178.66 ± 23.47,185.41 ± 22.67,213.17 ± 26.75 in the test group,the differences were statistically significant (t=6.839, 10.241, 13.926, P<0.01). Conclusions The construction of the ureterostomy self-management program, enhance patients'self-management consciousness, and improve the ability of self-management.

The clinical application of wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy / 中华泌尿外科杂志

Objective To discuss the effect and value of wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy as urinary diversion after radical cystectomy.Methods The clinical data of 12 cases(7 males and 5 females)with bladder cancer during January 2016 and September 2017 were retrospectively analyzed.The median age was 77 years (range 75-83),and the course of the disease was 5 days to 2 years.11 cases had gross hematuria,5 cases had frequent and urgent urination,1 case had lower abdominal pain,and 1 case had no obvious clinical symptoms.9 cases had a history of transurethral prostatic resection.8 cases had a complication of hypertension,5 cases had a complication of diabetes,7 cases had a complication of cardiovascular and cerebrovascular diseases,and 6 cases had a complication of anemia.The ASA level was 3 in 9 cases and was level 4 in 3 cases.All the patiants were diagnosed of bladder urothelial carcinoma by biopsy.There were 8 cases with T3 tumor and 4 cases with T4.All the patients underwent laparoscopic radical cystectomy under general anesthesia,and wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy was used for urinary diversion.Take a segment of 3-5 cm wide pedicle omentum,which is covered from the distal end of the ureter to the end,and use a 4-0 absorbable line to fix the omentum and ureteral outer membrane,and then perform ureterocutaneostomy.The incidence of postoperative anastomotic stenosis,hydronephrosis and wound infection were observed.Results All the operations were performed successfully without obvious operative complications.The mean operating duration was125 (95-217) mins,estimated volume of blood loss 120 (50-600)ml.5 days after surgery,1 patient developed incision infection,which was cured by strengthening anti-infection drug therapy and wound dressing.No complications such as urinary fistula,intestinal fistula and peripheral hernia occurred.No death was reported during perioperative period.Single J tube was removed 1-3 months after surgery.Within a follow-up of 12 (3-23) months,1 case died of cerebral infarction 3 months after surgery,1 case occurred papilla light constriction without special treatment,no ureteral stenosis and necrosis cases and there were no cases of hydronephrosis.All the patients were satisfied with the quality of life after surgery.Conclusions Wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy is simple,safe and effective as urinary diversion after radical cystectomy.

Impact of different surgical methods of radical cystectomy on the perioperative com-plications in patients over 75 years / 北京大学学报(医学版)

Objective:To analyze the impact of different surgical methods on perioperative complication rate after radical cystectomy in patients over 75 years of age.Methods:A retrospective study reviewed 1 432 patients who received radical cystectomy from January 2003 to January 2015.A total of 239 pa-tients were ≥75 years (median age:78 years),of whom,74 patients (31.0%)suffered one or more perioperative complications.According to the different operation methods,patients could be divided into ileal conduit group and cutaneous ureterostomy group.The ileal conduit group included laparoscopic and open radical cystectomy with ileal conduit.The cutaneous ureterostomy group included transperitoneal laparoscopic,transperitoneal and extraperitoneal open radical cystectomy with cutaneous ureterostomy. Results:Perioperative complications were significantly associated with the patient’s age (P =0.012), American Society of Anesthesiologists (ASA)score (P =0.001),node staging (P =0.043),and dif-ferent surgical methods.Perioperative complications caused a prolonged hospital stay and delayed recovery (34 d vs.21 d,P =0.002).For different surgical methods,the perioperative complication rate of ileal conduit was higher than cutaneous ureterostomy (P =0.013).However,there were no significant differences between transperitoneal laparoscopic and open radical cystectomy with ileal conduit in perioperative complication rate (P =0.836).The perioperative complication rate was statistically signifi-cant among transperitoneal laparoscopic,transperitoneal and extraperitoneal open radical cystectomy with cutaneous ureterostomy (P =0.022).On multivariate analysis,age (hazard ratio =4.856,95% CI:1.465 -16.103,P =0.010),ASA score (P =0.008),and different surgical methods (P =0.016) were significantly associated with the perioperative complication rate.Conclusion:The perioperative complication rate after radical cystectomy in elderly patients was associated with the patients’age,ASA score,and different surgical methods.Patients who received extraperitoneal open radical cystectomy with cutaneous ureterostomy suffered fewer perioperative complications,which was an appropriate choice for elderly patients.

Comparison of the quality of life between modified and traditional cutaneous ureterostomy / 中国医师进修杂志

Objective To compare health related quality of life (HRQOL) between modified and traditional cutaneous ureterostomy, and explore the reasons for these differences, in order to provide the basis of HRQOL for the choice of cutaneous ureterostomy. Methods A total of 53 patients underwent cutaneous ureterostomy were selected, and the patients were divided into traditional cutaneous ureterostomy group (traditional group, 21 cases) and modified cutaneous ureterostomy group (modified group, 32 cases) according to the surgery method. The patients were evaluated by functional assessment of cancer therapy-bladder (FACT-BL), and the HRQOL was compared between 2 groups. Results There were no statistical differences in HRQOL score at 1, 3, 6 and 9 months after surgery between 2 groups (P>0.05). The HRQOL score at 12 months after surgery was significantly higher in modified group than that in traditional group:(141.5 ± 10.4) scores vs. (123.1 ± 5.2) scores, and there was statistical difference (P0.05). But the scores of functional status and bladder cancer special scale (BSS), total score of FACT-BL in modified group were significantly higher than those in traditional group:(26.0 ± 2.5) scores vs. (23.8 ± 3.5) scores, (46.7 ± 6.2) scores vs. (34.8 ± 5.5) scores, (143.9 ± 15.7) scores vs. (117.5 ± 8.1) scores, and there were statistical differences (P<0.01). Conclusions The HRQOL at 12 months after surgery in modified cutaneous ureterostomy is better than that in traditional cutaneous ureterostomy. Therefore, if the patient's physical condition permits, priority should be given to modified cutaneous ureterostomy to reduce the complications and improve the quality of life.

A Single-Institution Experience with Metallic Ureteral Stents: A Cost-Effective Method of Managing Deficiencies in Ureteral Drainage

IntroductionThe limitations of traditional ureteral stents in patients with deficiencies in ureteral drainage have resulted in frequent stent exchanges. The implementation of metallic stents was introduced to improve the patency rates of patients with chronic upper urinary tract obstruction, obviating the need for frequent stent exchanges. We report our clinical experiences with the use of metallic ureteral stents in the management of poor ureteral drainage.Materials and MethodsFifty patients underwent metallic ureteral stent placement from 2009 to 2012. Stent failure was defined as an unplanned stent exchange, need for nephrostomy tube placement, increasing hydronephrosis with stent in place, or an elevation in serum creatinine. Stent life was analyzed using the Kaplan-Meier methodology, as this was a time dependent continuous variable. A cost analysis was similarly conducted.ResultsA total of 97 metallic stents were placed among our cohort of patients: 63 in cases of malignant obstruction, 33 in the setting of cutaneous ureterostomies, and 1 in an ileal conduit urinary diversion. Overall, stent failure occurred in 8.2% of the stents placed. Median stent life was 288.4 days (95% CI: 277.4-321.2 days). The estimated annual cost for traditional polymer stents (exchanged every 90 days) was $9,648-$13,128, while the estimated cost for metallic stents was $4,211-$5,313.ConclusionOur results indicate that metallic ureteral stent placement is a technically feasible procedure with minimal complications and is well tolerated among patients. Metallic stents can be left in situ for longer durations and provide a significant financial benefit when compared to traditional polymer stents.

Diagnostic Criteria for Stomal Obstruction of Tubeless Cutaneous Ureterostomy by Use of 99mTc-Mercaptoacetyltriglycine Diuretic Renography

PURPOSE: To evaluate 99mTc-mercaptoacetyltriglycine diuretic renograms for diagnosing stomal obstruction in tubeless cutaneous ureterostomy. MATERIALS AND METHODS: Cutaneous ureterostomy was performed in 29 patients (56 renal units) with a minimum follow-up period of 12 months. Stomal obstruction was evaluated with 99mTc-mercaptoacetyltriglycine diuretic renography 3 months after surgery. Regions of interest were drawn that completely encircled and snugly fit the kidney, renal pelvis, and ureter. The data analyses were performed with half-times to tracer clearance following furosemide (0.5 mg/kg) administration. RESULTS: The mean half-times to tracer clearance were 6.90+/-6.30, 5.25+/-4.29, and 8.75+/-7.63 minutes in the total, ipsilateral, and contralateral kidneys, respectively, in side relationships between the ureter and the stoma. There were significant differences between the ipsilateral and contralateral kidneys in the mean half-time to tracer clearance (p=0.038). Forty-eight renal units (85.7%) had a half-time to tracer clearance of less than 15 minutes, and all 48 renal units had no hydronephrosis. On the other hand, 5 renal units (8.9%) had a half-time to tracer clearance of more than 20 minutes, and these 5 renal units required the insertion of stent catheters or became atrophic. CONCLUSIONS: 99mTc-mercaptoacetyltriglycine diuretic renography was very useful for diagnosing stomal obstruction of tubeless cutaneous ureterostomy. The upper limit of the half-time to tracer clearance for unobstructed systems was 15 minutes, which allowed for the confident exclusion of stomal obstruction in tubeless cutaneous ureterostomy.

Evaluations for Hydronephrosis After the Establishment of Tubeless Cutaneous Ureterostomy

PURPOSE: To investigate hydronephrosis after the establishment of tubeless cutaneous ureterostomy by using our definition of the tubeless condition and our indications for catheter insertion. MATERIALS AND METHODS: Twenty-eight (54 renal units) patients with both establishment of tubeless cutaneous ureterostomy 3 months after surgery and at least 12 months of follow-up were investigated in this study. The 4-grade system was used to evaluate the hydronephrosis. The definition of the tubeless condition in cutaneous ureterostomy was as follows: 1) the catheter stent is not placed in the renal pelvis through the stoma, 2) the grade of hydronephrosis is less than 3, and 3) the kidney is functioning. Indications for catheter insertion after the establishment of tubeless cutaneous ureterostomy were as follows: 1) difficulty in curing acute pyelonephritis by drug treatments, 2) flank pain due to hydronephrosis, or 3) increase in the grade of hydronephrosis. RESULTS: The follow-up period was 12 to 78 months (average, 40.5+/-22.1 months). After the establishment of tubeless cutaneous ureterostomy, 6 of 54 renal units (11.1%) were eligible for catheter insertion. The catheter insertion was performed in 4 renal units. Another 2 renal units were followed up without intervention, and they gradually became atrophic. The renal functions were preserved in the other 52 renal units. CONCLUSIONS: Our results suggest that our definition of the tubeless condition and our indications for catheter insertion would be useful for the evaluation and management of hydronephrosis after establishment of tubeless cutaneous ureterostomy.

Cirugía conservadora de anomalías asociadas a la duplicación ureteral: 40 años de experiencia / Conservative surgery of anomalies associated to the ureteral duplication: 40 years of experience

Objetivo: Exponer la experiencia del Servicio de Urología del Hospital Provincial Pediátrico, el tratamiento de las anomalías asociadas a la duplicidad ureteral. Métodos: Se hizo una revisión retrospectiva de 378 pacientes con duplicación ureteral, entre 1970 al 2010; se realizó tratamiento quirúrgico conservador a 26 casos y 6 casos de ellos tenían edad pediátrica, los cuales son objeto de análisis en este trabajo, según datos obtenidos en el registro de documentación médica de los centros. De los seis casos operados, a cinco se les realizó cirugía conservadora (uréteropielóstomia), y en un caso se realizó nefrectomía polar superior. Resultados: La duplicidad ureteral es una patología frecuente, determina un estasis urinario. El uréter bífido extra vesical, provoca reflujo urétero-ureteral. Conclusiones: Esta técnica quirúrgica es útil en las en las anomalías asociadas a la duplicidad ureteral. No se debe utilizar ésta cuando no haya posibilidades de conservación de parénquima renal.

Objective: To expose the experience of the Urology Service of the Teaching Pediatric Provincial Hospital, in the treatment of the anomalies associated with the ureteral duplication. Methods: We retrospectively reviewed the medical records of 378 patients with Ureteral Duplication attended in our center in the period 1970-2010; the surgical treatment was applied in 26 cases, and 6 of them were pediatric cases; the last ones are analyzed in this work, taking into account data obtained from the Clinical Documentation Database of the centers involved. The conservative surgery (uretero-pyelostomy) was carried out in 5 patients of the 6 cases and in the other 1 case, an upper pole we made upper pole nephrectomy. Results: The ureteral duplication is a frequent pathology that determines a urinary stasis. The extra-vesical bifid ureter causes uretero-ureteral reflux. Conclusions: This surgical procedure is useful in the anomalies associated with the ureteral duplication. It should not be used when there are not possibilities of conserving the renal parenchyma.

Long-Term Urinary Bladder Function Following Unilateral Refluxing Low Loop Cutaneous Ureterostomy

PURPOSE: Unilateral low loop cutaneous ureterostomy (LLCU) has been offered as the preferred method of temporary urinary diversion in cases of massively dilated and refluxing ureters. We sought to explore whether LLCU is effective in preserving urinary bladder function in the long term. MATERIALS AND METHODS: The charts of all patients who had undergone temporary unilateral LLCU as newborns in the presence of massive vesico-ureteric reflux were retrospectively reviewed. Demographic data, follow-up length, and presence of incontinence were recorded. Patients were interviewed regarding lower urinary tract symptoms (LUTS), and their urination patterns were recorded by using uroflow and post-void residual (PVR) measurements. RESULTS: Between 1972 and 2003, a total of 24 patients underwent unilateral LLCU in the presence of massively refluxing ureters. Eight patients were included in the final analysis. The median age at diversion was 12 days, the median time to closure was 22.5 months, and the median follow-up was 12.5 years. Urinary bladders showed normal contour, normal capacities, and minimal PVRs in most cases. None of the patients required augmentation cystoplasty. One patient suffered from urinary leakage and few demonstrated minimal LUTS. CONCLUSIONS: Unilateral refluxing LLCU is an effective method of urinary diversion that preserves urinary bladder function for the long term. Larger studies are required to confirm this finding.

A Patient with Hinman's Syndrome who Underwent Renal Transplantation Using a Pre-existing Cutaneous Ureterostomy / 대한비뇨기과학회지

It is known that many renal transplantation candidates with end stage renal disease have bladder dysfunction. Before 1966, these patients were considered poor candidates for renal transplantation because of their many bladder problems. But it has recently been reported that renal transplantation with an ileal conduit could solve these problems. Herein, we report on a patient with Hinman's syndrome and this patient underwent renal transplantation using a pre-existing cutaneous ureterostomy.

Native Ureterotransplant Ureterostomy for Ureteral Obstruction after Simultaneous Pancreas Kidney Transplantation

Significant surgical complications occur in about half of patients after simultaneous pancreas kidney transplantation (SPK) with bladder drainage. Urologic complications are very common in bladder-drained pancreas transplants. Urinary obstruction occurs in either the early or the late period following transplantation. Predictors of urological complications after transplantation have not been well established. Early obstruction is usually diagnosed by an increment of serum creatinine or through imaging studies, such as ultrasound and antegrade pyelogram. Surgical management is inevitable when conservative managements fails. If the length of the donor ureter is sufficient, it is possible to redo the ureteroneocystostomy. However, if this is not the case or the stricture is at a high level, a native ureterotransplant ureterostomy may be the procedure of choice. SPK was performed on a 36 year old male patient with insulin dependent diabetes mellitus and diabetic nephropathy. The pancreatic exocrine secretion was drained by duodenocystostomy. The patient developed an obstruction in upper ureter on the postoperative 16th day. On the postoperative 32nd day, a native ureterotransplant ureterostomy with a double J stent was performed. The postoperative course was uneventful. The double J stent was removed on postoperative 112nd day by cystoscope. A subsequent follow up showed excellent pancreatic and renal function.