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Urinary diversion
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
A cutaneous ureterostomy is used as a temporary measure in carefully selected cases for decompression of the upper tracts. Debate still exists as to its role in PUV with deteriorating upper tracts either as a primary procedure or even after valve fulguration. We have used this method in selected children <1 year of age with solitary kidneys and a vesicoureteric junction obstruction with deteriorating renal function. A ureterostomy may also be performed where malignancy necessitates large pelvic resections. In selected cases of PUV with gross unilateral VUR, a refluxing ureterostomy may be performed on the side of reflux concomitant to valve resection to act as a “pop-off” mechanism and thereby protect the upper tracts. The ureterostomy may be created distally or proximally. The description below is of a distal ureterostomy.
Obstructing congenital anomalies of the urinary tract: ureteropelvic junction obstruction, ureterocele, megaureter, and posterior urethral valves
Published in J Kellogg Parsons, E James Wright, The Brady Urology Manual, 2019
Diverting ureterostomy: Good option for newborns with massive dilatation and evidence of renal impairmentMay improve ureteral tone and functionAllows recovery/stabilization of renal functionPerformed through extraperitoneal low inguinal approach.
The Abdomen
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
In the case of loss of long segments where anastomosis to the contralateral ureter is not possible, an end-ureterostomy could be brought out, or nephrectomy done in rare cases of serious associated injuries in the area.
Creation of a Continent Urinary Bladder Reservoir Vascularized by Omentum as a Possible Surgical Option for Canine Trigonal/Urethral Urothelial Carcinoma
Published in Journal of Investigative Surgery, 2022
Annemarieke de Vlaming, Kyle G. Mathews, Jonathan A. Hash, Erin K. Keenihan, Samantha Sommer, Luke Borst, Shelly L. Vaden
Group C was designed to represent a clinical scenario of primary tumor removal and continent neoreservoir creation. The results obtained from Groups A and B dogs regarding bladder viability aided in determining the surgical procedure for Group C. A staged surgical approach was implemented for dogs in Group C following a protocol similar to that described for Group B with the addition of ureteral reimplantation (Figure 4). During the first surgery just prior to omentalization, bilateral neoureterocystostomy was performed in preparation for future distal bladder/urethral transection. For neoureterocystostomy the ureters were identified and the distal 2/3 isolated to decrease tension. The previously described vesicular arteries were also identified and major branches ligated proximal to the ureterovesicular junctions. The ureters were sequentially ligated using 4-0 PDS and transected 3-4mm proximal to the ureterovesicular junctions. Residual fat was dissected from the free ureteral ends and the ureters spatulated. An extravesicular technique as previously described [36] was performed using 6-0 PDS in two simple continuous patterns for reimplantation bilaterally along the left and right ventroapical aspects of the bladder. A 3.5 Fr red rubber catheter was placed into the bladder lumen via a separate stab incision and passed into each ureter during suturing to prevent inadvertent catching of the opposite wall during ureterostomy. After neoureterocystostomy and closure of the stab incision, bladder omentalization was performed as previously described for Group B. The abdomen was closed routinely.
Expanding the indications of robotic surgery in urology: A systematic review of the literature
Published in Arab Journal of Urology, 2018
Raj P. Pal, Anthony J. Koupparis
On review of the literature we identified 17 studies (Table 5 [66–82]) evaluating distal ureteric reconstructive surgery, with institutions presenting their experience using a number of differing techniques including uretero-ureterostomy and uretero-neocystostomy (often with adjunct procedures such as Boari flap formation or Psoas hitch).
End-to-end ureteroureteroanastomosis with unilateral nephrostomy: revival of a forgotten technique suitable for a modern context?
Published in Scandinavian Journal of Urology, 2019
Georg Jancke, Gediminas Baseckas, Johan Brändstedt, Petter Kollberg, Anne Sörenby, Fredrik Liedberg
Ureteroureterostomy can be suitable in some patients, especially those with a pre-operatively inserted nephrostomy tube and being treated in a palliative setting for urinary obstruction and an unresectable primary pelvic tumour, if immediate palliative chemotherapy is planned after surgery or if ureterocutaneostomy is difficult to perform (for example in obese patients). In Sweden, the most common urinary diversion after cystectomy is the ileal conduit, which was performed in 87% of all patients treated with radical cystectomy for primary invasive bladder cancer in 2015 [4]. The use of bowel contributes significantly to post-operative complications and long-term complications after radical cystectomy. In one retrospective analysis [5], major complications (Clavien grade 3 − 5) decreased from 25% to 12% when urinary diversion was achieved by cutaneous ureterostomy rather than using the bowel. However, cutaneous ureterostomy is hampered by a high risk of stomal stenosis, and patients usually have permanent single-J stents that must be changed on a regular basis. Furthermore, even though some authors have suggested use of non-stented stomas [6], stomal stenosis occurred in 13% of their patients despite that long-term single-J stents being used for at least 6–12 months post-operatively. Hence, end-to-end ureterostomy with unilateral nephrostomy is a potential alternative to cutaneous ureterostomy, particularly when a nephrostomy tube has already been inserted prior to surgery. Additionally, in patients with previous pelvic irradiation, end-to-end ureterostomy offers the possibility to resect the ureters and perform an anastomosis outside the radiation field, and this also applies to obese patients when cutaneous ureterostomy is technically more demanding. In addition, when an obvious palliative situation is met at surgical exploration for advanced disease, urinary diversion for local symptoms is easily achieved by an end-to-end ureterostomy. Six of the eight patients in this case series suffered infectious complications and/or nephrostomy tube obstruction in the early post-operative setting during the first 90 days after surgery. Pyelonephritis is a well-known sequela after nephrostomy tube placement, and the majority of such infections are associated with the primary nephrostomy tube [7]. One of the theoretical disadvantages of nephrostomy compared to cutaneous ureterostomy is a unilateral nephrostomy tube draining both upper urinary tracts with antiperistaltic flow of urine, which might affect the clearance of urine infected with bacteria [8]. However, by performing a wide anastomosis (Figures 4 and 5), a non-obstructed MAG-3 renography is obtained even if a secondary peak occurs when the isotope from the left side emerges in the right renal pelvis (Figure 6).