Korean J Urol.  2013 Mar;54(3):168-171.

Evaluations for Hydronephrosis After the Establishment of Tubeless Cutaneous Ureterostomy

• Kim CJ
• Sano T
• Murai R

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.

Keyword

Complications; Ureteral obstruction; Ureterostomy; Urinary bladder neoplasms; Urinary diversion

MeSH Terms

Catheters
Flank Pain
Follow-Up Studies
Humans
Hydronephrosis
Kidney
Kidney Pelvis
Pyelonephritis
Stents
Ureteral Obstruction
Ureterostomy
Urinary Bladder Neoplasms
Urinary Diversion

Figure

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  FIG. 1 Case 1. (A) Abdominal computed tomography revealed a sac protruding through an area of the abdominal wall in proximity to the stoma. (B) The abdominal wall tunnel for the ureters was constructed in the extreme lateral area of the rectus muscle. The arrow shows the abdominal wall tunnel.

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  FIG. 2 Case 2. (A) Abdominal computed tomography (CT) revealed the ureters at the level of the abdominal wall tunnel for the ureters 5 months after surgery. (B) Abdominal CT revealed the obstruction of the ureters at the level of the posterior sheath of the rectus muscle 15 months after surgery. The arrow shows bilateral hydroureters.

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