Long-term outcome of ureterosigmoidostomy: an analysis of patients with >10 years of follow-up
Article first published online: 13 AUG 2009
© 2009 THE AUTHORS. JOURNAL COMPILATION © 2009 BJU INTERNATIONAL
Volume 105, Issue 6, pages 860–863, March 2010
How to Cite
Tollefson, M. K., Elliott, D. S., Zincke, H. and Frank, I. (2010), Long-term outcome of ureterosigmoidostomy: an analysis of patients with >10 years of follow-up. BJU International, 105: 860–863. doi: 10.1111/j.1464-410X.2009.08811.x
- Issue published online: 25 FEB 2010
- Article first published online: 13 AUG 2009
- Accepted for publication 15 May 2009
- urinary diversion;
- bladder cancer;
- surgical complications
Study Type – Therapy (case series)
Level of Evidence 4
To examine our long-term experience with ureterosigmoidostomy (USS) to evaluate its potential applicability in the treatment of benign and malignant conditions of the urinary bladder, as USS has been largely disregarded recently, secondary to concerns of long-term complications, but has had a resurgence of interest due to its potential applicability to newer minimally invasive surgical techniques.
PATIENTS AND METHODS
We identified 51 patients who had USS from 1956 to 2006 at our institution and with >10 years of follow-up. The patients were followed retrospectively by a chart review. Patient data were analysed in a multifaceted fashion, paying particular attention to metabolic abnormalities, early (≤30 days) and late (>30 days) complication rates, continence rates, imaging changes, and the rate of repeat surgical intervention.
The median (range) follow-up was 15.7 (10.0–45.4) years and the median age at surgery was 58.8 (0.4–79.0) years; 40 (79%) patients had the procedure for malignancy and 11 (22%) for benign disease. Six patients (12%) had at least one early complication, including one wound dehiscence and one pulmonary embolus. In all, 22 patients (43%) had at least one late complication, with anastomotic stricture being the most common (11/51, 22%). This was followed by recurrent pyelonephritis in eight patients (16%), stones in five (10%), chronic renal insufficiency in three (6%) and severe intractable acidosis in two (4%). A repeat surgical intervention was required in 19 (37%) patients. In all, 94% (48) reported complete continence. No patient developed colonic malignancy during the course of this study.
USS is associated with long-term complications. While this complication rate might not be acceptable for all patients, some might be willing to undergo the procedure as the primary method of urinary diversion. When designing newer minimally invasive techniques for the treatment of benign and malignant conditions of the bladder, consideration could be given to USS as a form of urinary diversion in highly selected patients.