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

• Published in: Acta cirúrgica brasileira 2013, Vol.28 (suppl 1), p.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: Article
• Language: English
• Subjects: Aged; ASA Score; Bladder Cancer Neoplasms; Morbidity; Posoperative Complication; Survival
• ISSN: 0102-8650; 0102-8650
• DOI: 10.1590/S0102-86502013001300009

PURPOSE: 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. METHODS: 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 indefinitly. Peri-operative morbidity and mortality were evaluated. RESULTS: 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. CONCLUSIONS: 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. OBJETIVO: Relatar a experiência do emprego da ureterostomia cutânea (UC) como forma de derivação urinária definitiva em pacientes portadores de neoplasia vesical avançada, em más condições clínicas e que necessitam de tratamento paliativo. MÉTODOS: Foram analisados retrospectivamente os parâmetros clínicos e operatórios de 41 pacientes submetidos a cistectomia radical e UC em três centros oncológicos especializados. A UC foi a derivação urinária escolhida quando os pacientes não apresentavam condições clínicas de serem submetidos a outro tipo de derivação . Foram avaliados a morbidade peri-operatória e a sobrevida global. RESULTADOS: A idade média dos pacientes foi de 69 anos (intervalo interquartil