チューブレス尿管皮膚瘻の治療成績

Abstract

We constructed Toyoda cutaneous ureterostomy with fixation between the anterior and posterior rectus sheath by four interrupted sutures to maintain the stability of the abdominal wall tunnel for the ureters. After the operation, the stent catheterswere placed in the renal pelvisthrough the stoma, and exchanged every 4 weeks. The stent catheters were removed 3 months after the operation, because the stomal conditions were unstable and obstructive in the early phase after the operation. Fifteen patients (27 renal units) with at least 6 months of follow-up were enrolled in this study. The follow-up period was 6 to 33 months(average 14.0±7.9). Radical cystectomy was performed for bladder cancer in these patients. There were 12 men and 3 women with an average age of 73.3±7.2 years. At the operation, the ureters were intact in all 27 renal units. Six monthsafter operation, 26 (96.3%) of 27 renal unitsachieved a tubeless condition, and 25 renal units (92.6%) had no hydronephrosis. Acute pyelonephritis had developed 2 (13.3%) of the 15 patientsboth within 3 monthsafter the operation and after thisperiod. In conclusion, our operative modification of cutaneousureteros tomy achieved a high catheter-free rate.