WOFAPS 2025 8th World Congress of Pediatric Surgery

Zukhra Sabirzyanova, Andrey Pavlov

Russian scientific center of roentgenradiology

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Ureterocutaneostomy is a temporary urinary diversion technique used as a staged of surgical treatment of megaureter in cause of severe condition and young age of the child, which don’t allow performing reconstructive surgery in small bladder capacity, significant decrease in renal function due to upper urinary tract urodynamic disorders and obstructive pyelonephritis. Despite of various techniques, it is believed that bringing the ureter to the skin is a traumatic surgery that inhibits the functional state of the ureter, and in case of bilateral, leads to loss of bladder volume.

To evaluate optimal ureterocutaneostomy techniques and their role in renal function rehabilitation in pediatric patients with megaureter.

MATERIALS AND METHODS

The study included 105 patients (82 with bilateral and 23 with unilateral megaureter, totaling 149 ureters) with three types of ureterostomas: Loop (82 cases), High Y-type (32 cases), Distal end stomas (35 cases)

RESULTS

The timing and degree of renal function recovery, restoration of anatomical and functional state of the ureter, necessity of forming ureterocysto-, ureteropyelo- or ureteroureteroanastomosis during closure, and possibility of using ureterocutaneoustoma for artificial access to the bladder for intermitted catheterization were analyzed.

Stoma type had minimal impact on urinary diversion. Three patients required continuous kidney drainage. Ureteral size reduction occurred within 3–6 months.

Closure principles varied. 70 loop and all Y-type stomas required primary ureterovesical junction correction (dilation or ureterocystoanastomosis), followed by closure of ureterocutaneous stoma with ureterouretero- or ureteropyeloanastomosis.

12 loop stomas underwent distal resection with ureterocystoanastomosis. Distal end stomas followed similar closure protocols

In 28 patients, the distal ureter served as artificial bladder access for rehabilitation. Six patients later underwent nephrectomy and ureterovesicostomy.

CONCLUSION

Ureterocutaneostomy proves effective in preserving and restoring renal function while enabling lower urinary tract rehabilitation. Individualized planning of urodynamic rehabilitation is crucial for optimal outcomes.