End Cutaneous Ureterostomy for the Management of Severe Hydronephrosis

Purpose: Although rarely indicated, surgical treatment of severe megaureter can pose a formidable technical challenge,especially in the small infant. We present our experience and outcomes with end cutaneous ureterostomy as a temporizingadjunct to future ureteral reimplantation.Materials and Methods: We performed a retrospective cohort study of patients who underwent end cutaneous ureterostomybetween 1993 and 2005. Patient demographics, surgical details and outcomes were recorded.Results: A total of 29 patients (22 males, 7 females) underwent diversion of 34 renal units. Primary megaureter wasdiagnosed in 15 patients (17 renal units). Secondary megaureter was found in 10 patients (12 renal units). Postoperativemegaureter was diagnosed in 4 patients (5 renal units). Mean patient age at time of diversion was 3.2 months for those withprimary megaureter and 1.4 years overall. Bilateral diversion or diversion of a solitary functioning kidney was performed in14 patients (48%), of whom 4 had renal insufficiency. Nine patients (31%) had a febrile urinary tract infection while awaitingundiversion, with no evidence of renal scarring on followup. Undiversion was performed in 12 patients (13 renal units) withprimary megaureter at a mean age of 18 months. Overall, undiversion was performed in 21 patients (23 renal units), andureteral tailoring was required in only 5 renal units (22%). Mean followup after undiversion was 4.2 years for primarymegaureter and 3.9 years overall.Conclusions: End cutaneous ureterostomy is a safe and effective procedure to temporize massive hydronephrosis whileawaiting definitive ureteral reimplantation.