Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy

• Published in: Acta cirurgica brasileira Vol. 28 Suppl 1; no. suppl 1; pp. 43 - 47
• Main Authors: Nogueira, Lucas, Reis, Rodolfo Borges dos, Machado, Roberto Dias, Tobias-Machado, Marcos, Carvalhal, Gustavo, Freitas, Jr, Celso, Magnabosco, Wesley, Menezes, Conrado Leonel, Corradi, Carlos, Reis, Leonardo Oliveira, Cologna, Adauto, Rodrigues Junior, Antonio Antunes, Faria, Eliney Ferreira
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia 2013
• Subjects: Aged; ASA Score; Bladder Cancer Neoplasms; Cystectomy - methods; Female; Follow-Up Studies; Humans; Male; Middle Aged; Morbidity; Palliative Care; Posoperative Complication; Retrospective Studies; Stents; Survival; Survival Analysis; Ureterostomy - methods; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - surgery; Urinary Diversion - instrumentation; Urinary Diversion - methods
• DOI: 10.1590/S0102-86502013001300009
• ISSN: 0102-8650

Simple diversions are underutilized, mostly for unfit, bedridden, and very self-limited patients requiring palliative surgical management due to life-threatening conditions. Experience with cutaneous ureterostomy (CU) as palliative urinary diversion option for unfit bladder cancer patients is reported. We retrospectively reviewed clinical and operative parameters of 41 patients who underwent CU following RC in three specialized Cancer Centers from July/2005 to July/2010. Muscle-invasive disease (clinical Stage T2/worse), multifocal high-grade tumor, and carcinoma in situ refractory to intravesical immunotherapy were the main indications for RC. Double-J ureteral stents were used in all patients and replaced every 6 months indefinitely. Peri-operative morbidity and mortality were evaluated. Median age was 69 years (interquartile range--IQR 62, 76); 30 (73%) patients were men. Surgery in urgency setting was performed in 25 (61%) of patients, most due to severe bleeding associated with hemodynamic instability; 14 patients (34%) showed an American Society of Anesthesiologists score 4. Median operative time was 180 minutes (IQR 120, 180). Peri-operative complications occurred in 30 (73%) patients, most Clavien grade I and II (66.6 %). There was no per-operative death. Re-intervention was necessary in 7 (17%) patients. Overall survival was 24% after 9.4 months follow-up. CU with definitive ureteral stenting represents a simplified alternative for urinary diversion after palliative cystectomy in unfit patients. It can be performed quickly, with few early and late postoperative complications allowing RC in a group of patients otherwise limited to suboptimal alternatives. Future studies regarding the quality of life are warranted.