Uretero-Ureterostomy Combined With Unilateral Nephrostomy as a Method of Urinary Diversion Following Radical Cystectomy

Abstract

IntroductionUretero-ureterostomy combined with unilateral nephrostomy is a rarely performed urinary diversion following radical cystectomy for muscle-invasive bladder cancer. The aim of this study is to assess the efficacy and safety of the procedure. Materials and methodsPatients with muscle-invasive bladder cancer and poor performance status were enrolled in this retrospective, observational, single-centre study, carried out between December 2018 and November 2020. The patient's renal function was regularly assessed with serum creatinine and estimated glomerular filtration rate (eGFR). Evaluation of peri-and postoperative complications was performed based on clinical, laboratory, endoscopic, ultrasound and other radiological studies findings. The patient's status was assessed for 12 months. ResultsThirty-six patients with a mean age of 77.4±8.6 years were enrolled in the study. 86.11% of patients had an American Society of Anesthesiologists Score ≥3 and 91.66% had an age-adjusted Charlson comorbidity index of ≥6. Slight deterioration of renal function, although not statistically significant, was observed. 36.11% of the patients developed permanent unilateral pelvic dilatation. Acute pyelonephritis, urosepsis, pyonephrosis and anastomotic leak were observed in 22.22%, 8.33%, 5.55% and 5.55% of patients, respectively; all were treated either conservatively and/or with minimally invasive procedures (nephrostomy, JJ-stent insertion) without any need for open surgical revision. ConclusionsUreteroureterostomy combined with unilateral nephrostomy is a safe and effective method of urinary diversion following radical cystectomy for muscle-invasive bladder cancer with easily manageable complications.

Twenty-Four-Month Efficacy of Ureteroureterostomy Combined With Unilateral Nephrostomy Following Radical Cystectomy

“…The demographic data and size of the cohort of our study, which was conducted in the Department of Urology, Agaplesion General Hospital Hagen, Germany, remained unchanged compared to our previous publication [5], as presented in Table 1. The diagnostic criteria of acute pyelonephritis were a positive urine culture (>10 5 colony-forming units) and clinical signs of either frank pain or tenderness with fever (38.5˚C), which was observed in the absence of another indication for fever.…”

“…The demographic data and size of the cohort of our study, which was conducted in the Department of Urology, Agaplesion General Hospital Hagen, Germany, remained unchanged compared to our previous publication [ 5 ], as presented in Table 1 .…”

“…A detailed description of the surgical procedure and its peri and postoperative course is presented in our previous publication [ 5 ]. We previously reported that ureteroureterostomy combined with unilateral nephrostomy is a safe and effective method of UD following radical cystectomy for muscle-invasive bladder cancer (BC) with easily manageable complications within the first 12 months after surgery [ 5 ]. We are currently presenting the 24-month outcomes after ureteroureterostomy combined with unilateral nephrostomy following radical cystectomy for muscle-invasive BC.…”