Evaluations for Hydronephrosis After the Establishment of Tubeless Cutaneous Ureterostomy

ABSTRACT

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.