Cutaneous Ureterostomy

Laparoscopic cutaneous ureterostomy is a valuable palliative procedure in the management of distal ureteral obstruction from advanced pelvic cancers such as prostate, bladder, and uterine cancer.

It is a more permanent form of urinary diversion than percutaneous nephrostomy and may be more advantageous in patients who require repetitive nephrostomy tube exchanges (16). Puppo et al. reported their initial experience in four cases with excellent results. Operative times ranged from 1.2 to 2.2 hours, and estimated blood loss was negligible in one, less than 50 cc in two, and less than 150 cc in the fourth case. All patients tolerated the procedure well and were discharged home between postoperative day 5 to day 11 (17). These same investigators then reported six more laparoscopic cutaneous ureterostomies via both the transperitoneal and retroperitoneal approach with similar success (18). Operative times were similar between 35 minutes to 2.2 hours minutes, and postoperative patient analgesic requirements were minimal. The technical approach to the ureter is similar to that already described in the above sections. The cutaneous stoma can be matured at any convenient site on the abdominal wall as performed in open surgery.

In a slight variation of simple diversion, cutaneous ureterostomy can also be used for urinary bladder diversion in the form of a catheterizable stoma for selected patients with a neurogenic bladder. Strand et al. reported an interesting case where the ipsilat-eral ureter from the nonfunctioning renal unit was brought out to the skin and used as a cutaneous catheterizable ureterovesicostomy (19). The laparoscopic portion of the case was 250 minutes, and postoperative recovery was uneventful.

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