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Revista Colombiana de Cirugía
Print version ISSN 2011-7582On-line version ISSN 2619-6107
Abstract
BARRERA-LOZANO, Luis Manuel; GUTIERREZ-MONTOYA, Jorge Iván and HENAO-SIERRA, Jorge. Cutaneous ureterostomy as definitive urinary diversion in kidney transplant. rev. colomb. cir. [online]. 2020, vol.35, n.4, pp.630-638. Epub Feb 15, 2021. ISSN 2011-7582. https://doi.org/10.30944/20117582.485.
Introduction.
About 15% of patients with end-stage chronic renal failure have lower urinary tract abnormalities. These abnormalities were considered a contraindication for kidney transplantation. Therefore, the objective of the present work is to describe the sociodemographic and clinical behavior of renal transplant patients with skin ureterostomy as a definitive urinary tract bypass technique.
Methods.
A descriptive, longitudinal and retrospective study of renal transplant patients with abnormal bladder and skin ureterostomy was conducted between January 1973 and October 2012.
Results.
We performed 24 (0.55%) ureterostomies in 4.294 kidney transplants. Nineteen (79.1%) were used as first and definitive urinary diversion, and five were ureteroneocystostomies that failed and required ureterostomy as alternative diversion. Ten (41.7%) ureterostomies failed, most (eight cases) from stenosis. Urinary tract infection (UTI) were present in 20 patients and mortality was 8.3% (2/24); 50% (12/24) of kidney transplants were free of urinary tract infection during the first year. The survival of the transplanted kidney was 93.8% (23/24) at 18 months, 85.9% (20/24) at 36 months, and 66.8% (16/24) at 50 months of follow up. The survival of grafts with ureterostomy without urinary tract infection were 100% during the follow-up period, while the survival of the kidneys with UTI was 93% (23/24) at 18 months, 76% (18/24) at 36 months, and 54% (13/24) at 50 months (p=0.235).
Conclusions.
Cutaneous ureterostomy is a safe alternative for urinary diversion in transplanted renal patients with bladder abnormalities that cannot be prepared or used for a routine diversion before transplantation.
Keywords : kidney; kidney transplantation; urinary bladder; ureter; ureterostomy.