What Is a Ureterostomy?

Skin ureterostomy, skin ureterostomy is used for the surgical treatment of ureteral and bladder diseases. Urethral diversion is a procedure that changes the normal discharge of urine from the urethral orifice. Diverted urinary tract surgery can be divided into temporary and permanent categories.

Skin ureterostomy

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Skin ureterostomy, skin ureterostomy is used for the surgical treatment of ureteral and bladder diseases. Urethral diversion is a procedure that changes the normal discharge of urine from the urethral orifice. Diverted urinary tract surgery can be divided into temporary and permanent categories.

Chinese name

Skin ureterostomy

Skin ureterostomy

Pediatric surgery / ureter and

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Skin ureterostomy is used for the surgical treatment of ureteral and bladder diseases. Urethral diversion is a procedure that changes the normal discharge of urine from the urethral orifice. Diverted urinary tract surgery can be divided into temporary and permanent categories.

In addition to kidney, ureter, bladder, urethrostomy (or ostomy), urinary diversion surgery often uses the following methods: use a free bowel to make a stoma in the abdominal wall as a channel for urine flow. Such as ileal bladder surgery and controllable ileal bladder surgery developed on this basis. Urine-fecal conjunctiva surgery, such as ureteral sigmoid anastomosis. The urinary flow developed in recent years does not divert, but the intestinal canal is used for bladder replacement surgery, such as ileal bladder surgery.

Skin ureterostomy is simpler than ileal bladder, and it has the advantage of not disturbing the abdominal cavity, especially when the one kidney is accompanied by ureteral dilatation. The disadvantage is that in a few cases, necrosis of the end of the ureter can occur, causing stenosis and requiring the drainage tube to be left in place for a long time.

Skin ureterostomy is suitable for:

1. Indications for temporary urinary tract surgery: severe bladder ureteral reflux; ureteral bladder obstructive disease; refractory urinary tract infection; some urethral obstructive disease

2. Indications for permanent urinary diversion: neuronal bladder; ectopic bladder; after cystectomy.

Continuous epidural block anesthesia or general anesthesia. In the supine position, the head is slightly lowered.

1. Inferior oblique incision in the abdomen, surgery is performed transperitoneally. If cystectomy is required at the same time, a midline incision or transverse incision is used.

2. Free the middle and lower sections of the ureter after the peritoneum, and pay attention to preserving its blood supply. The ureter was cut off near the bladder, and the distal end was ligated with silk thread. The corresponding thickness of the drainage tube was inserted into the renal pelvis at the proximal end and fixed.

3. Pull out the ureter at the level equivalent to the upper edge of the palate, and cut a little vertically through the incision muscles and aponeurosis along the incision wound edge, but it should not be cut too much to avoid abdominal wall hernia after operation. Use 3 to 4 needle filaments to pass through the outer membrane of the ureter to fix the external oblique tendon. Suture the subcutaneous and skin incisions.

4. Turn the ureter out into a nipple style, and fix it with silk suture to the skin margin.

5. If a bilateral ureter skin stoma is required, the opposite side can be performed in the same way. Due to the bilateral incision, it can cause inconvenience to the sick child. The side with a smaller diameter can be pulled to the opposite side through the anterior iliac crest and the back of the sigmoid colon. mouth.

1. When the middle and lower ureter is exposed, the ureter is often close to the peritoneum, which is easily pulled apart and covered by the hook, which makes it difficult to find the ureter.

2. When free ureters, as much as possible surrounding tissue should be brought, and the free length is only enough for skin stoma to ensure blood supply to the ureter and prevent necrosis at the end of the ureter.

3. When the ureteral effusion is obvious, it looks like a small intestine, and it should be distinguished from the intestine. The ureter is located behind the peritoneum and has a low degree of activity. A puncture may be performed if identification is difficult.

After skin ureterostomy, do the following:

1. Wrap the ureteral skin fistula with vaseline gauze and pay attention to keep the drainage tube open.

2. Use antibiotics to prevent infections.

3. After the wound has healed from 10 to 14 days, the ureteral drainage tube is removed and the urine bag is collected to collect urine. ^[1]

Ureteral necrosis at the end

This is the most common complication. In severe cases, not only exposed ureteral necrosis at the end, but also abdominal ureteral necrosis. It is mostly caused by inferior ureteral artery infarction. Therefore, care should be taken to protect the ureteral blood supply during the operation to prevent damage, and to protect the ureter with wet saline gauze to prevent the free ureter from drying out. Attention should be paid to avoid using an overly thick ureteral drainage catheter to press the ureteral wall Cause ureteral ischemia, etc., can prevent complications of ureteral necrosis.

2. Acute pyelonephritis

Caused by poor drainage of the ureteral drainage tube and retrograde infection. ^[2]

3. Narrow ureter skin fistula

This is a common late complication. The lighter can be cured by dilatation, incision and indwelling ureteral drainage tube for 4 to 6 weeks; the severer must be corrected by surgery. A ureteral defect can often be found during surgery. The ureter should be freed again during surgery and pulled out of the abdominal wall for external fixation. If there are many ureteral defects, the ureteral skin fistula site can be replaced according to the length of the free segment of the ureter.