Trans-mesosigmoid cutaneous ureterostomy

Background: A new method was developed in order to create a single stoma cu taneous ureterostomy in which both ureters traverse the abdominal cavity an d yet are buttressed by the mesosigmoid and covered by its visceral periton eum. Methods: The long mesenterium which is attached to the most mobile part of the sigmoid colon was used for the bilateral ureteral pathway. Tunnels for the ureteral path were made just underneath the visceral peritoneum on the bilateral side of the mesosigmoid. Through the tunnels both ureteral ends w ere brought from the retroperitoneal space to the mesenterocolonic junction (MCJ) and the MCJ is then approximated and sutured to the inside of the ur eteral tract through the abdominal wall. The ureters brought outside the sk in, are conjoined and sutured to the V skin flap. Eight patients who carrie d a high risk for operation and/or had a bladder tumor judged to be incurab le underwent this cutaneous ureterostomy. Results: All cases except one with low urinary output could be managed with out catheter indwelling during the follow-up period. Three patients suffere d from paralytic ileus and one required laparotomy for mechanical ileus dur ing the short postoperative period. postoperative excretory urography evalu ated 14 kidneys during the follow-up period from 2 to 61 months and showed normal upper urinary tract in Il and a mildly hydronephrotic tract in three . Conclusions: Transmesosigmoid cutaneous ureterostomy provides a single cath eterless stoma even when the available ureters are relatively short. It app ears to be a good method for supravesical urinary diversion when indicated.