Evaluation of usefulness of the laparoscopic ureterocutaneostomies in advanced pelvic tumors
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Maciej Szczębara, Andrzej Paradysz, Andrzej Kupilas, Marcin Życzkowski, Mieczysław Fryczkowski

Klinika Urologii w Zabrzu Śląskiego Uniwersytetu Medycznego w Katowicach

summary

Introduction.

Method of choice in treatment of renal urinary retention caused by compression or malignant infiltration on distal parts of ureters is puncture cutaneostomy. This is technically the simplest, repeatable and cheap method. Disadvantage, in cases when radiotherapy of tumor is required, is remaining urine confluence into the bladder. It commonly leads to severe urine derived infections especially when bladder emptying is impaired or in presence of accompanying urinary fistulas. Prolapsing of catheter is another common complication which additionally worsens previously impaired renal sufficiency. These complications usually make radio- or chemotherapy of the tumor impossible to be implemented. In such cases conventional operative ureterocutaneostomies are more appropriate procedure. Nevertheless conventional surgery requires separate access to each ureter, long hospitalization time and accompanying uraemia delay healing of wounds.

Objectives.

The aim is evaluation of usefulness of the laparoscopic ureterocutaneostomies in advanced pelvic tumors.

Materials and methods.

In our department 7 operations of bilateral laparoscopic ureterocutaneostomies were performed. In 3 cases uterine cervix cancer and in 4 cases inoperative bladder cancer were the causes of hydronephrosis. In patients before and after surgery standard laboratory tests were performed including creatinine levels, urine examinations and cultures. Laparoscopies were performed with three 10 mm ports.

Results.

ean age at operation was 58 years, average observation period was 26 months. Time of laparoscopy and hospitalization was 55min and 4 days respectively. No intraoperative complications were observed. 3 patients before operation had been diagnosed with pyuria and 6 patients with low grade renal failure. After surgery negative urine cultures were observed in all patients. Despite decrease in creatinin, in 4 patients renal insufficiency persisted.

Conclusions.

Laparoscopic ureterocutaneostomy: provides regression of symptoms and improves renal sufficiency; enables remissions of urine derived infections and leads to safe radiotherapy; allows for performing bilateral procedure with single access minimizing risk of wounds infection; creates abilities for estimation of tumor progression during operation.