EXTRAVESICAL URETERONEOCYSTOSTOMY - A REL IABLE TECHNIQUE FOR CORRECTION OF DISTAL URETERAL OBSTRUCTION IN METASTATIC PROSTATE-CANCER

Distal ureteral infiltration with urinary obstruction is a common comp lication of metastatic prostate cancer. Therapy is necessary in most c ases because of the symptoms and significant life expectancy of these patients. Within a period of 10 years, 30 patients received 40 uretera l reimplantations into the bladder roof using a simple extravesical te chnique without an anti-reflux mechanism. During follow-up, urinary fl ow was restored in all patients without substantial perioperative comp lications and further loss of renal function. Mean postoperative survi val time (n = 30) was 33 months. Patients with ureteral obstruction at the time of diagnosis of prostate cancer (n = 14) survived 41 months postoperatively. Compared to internal ureter stenting or percutaneous nephrostomy (risk of infection, repeated change of stents), the absenc e of a foreign body leads to significant improvement of quality of lif e in the operated patient. Under the aspect of the considerable surviv al periods, this advantage suggests that ureteroneocystostomy in indiv idual patients with prostate cancer and ureteral obstruction offers an attractive therapeutical approach.