End Cutaneous Ureterostomy: Our Approach, Tips & Tricks
Mark Zaontz, MD, Katherine M. Fischer, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Background: End cutaneous ureterostomy is a simple surgical technique to relieve ureteral obstruction in cases where ureteral reimplantation or other definitive reconstruction is not felt to be ideal at the time. It can be performed via a small groin incision and easily reversed at a later date once the patient is ready for ureteral reimplantation or other reconstructive surgery. Creation of an end cutaneous ureterostomy can help to relieve ureteral obstruction and prevent loss of renal function and urinary tract infection secondary to obstruction. IIn this video we demonstrate our technique for end cutaneous ureterostomy creation as well as illustrate key steps.
Methods: We created a video to demonstrate our approach to cutaneous ureterostomy creation highlighting key points and important anatomy.
Results: A 2cm groin incision is made and dissection carried down to the external oblique fascia which is opened. The external and internal oblique muscles are then split in a grid iron fascia to reach to retroperitoneum. Blunt dissection is used to sweep the peritoneal edge medially and expose the dilated ureter. Once the ureter is freed and well exposed it can be encircled with a vessel loop and stay sutures used to maintain correct orientation and control of the ureter. The ureter is then divided, and the distal stump suture ligated. The dilated proximal ureter is mobilized to ensure no kinking and remove redundancy. The ureter is then secured to the external oblique fascia ensuring correct orientation and no kinking. Finally, the redundant ureter is excised, and the ureteral mucosa matured to the skin full thickness with sutures. A dressing of Mastisol and Tegaderm is placed all around the edges of the ureterostomy at the end of the case and we find that this helps to prevent skin irritation and rash formation from urine.
Conclusions: We find this approach to end cutaneous ureterostomy creation to be an effective and reproducible way to alleviate ureteral obstruction with a low complication rate.
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