A Clinical Study Of Cutaneous Ureterostomy And Related Modified Method

Objective: To compare the clinical effects of cutaneous ureterostomy(CU)and ileal conduit(IC)after radical cystectomy in patients with bladder cancer and their effect on patients’ life quality,and to further compare the postoperative complications of MCU(modified cutaneous ureterostomy with the skin tube plasty using pedicled tongueshaped flap)with TCU(traditional cutaneous ureterostomy)in order to explore the effectiveness of modifiedcutaneous ureterostomy(MCU)and its clinical application.Methods: From January 2017 to March 2019,71 cases of bladder cancer with myometrial infiltration were selected from the urology department of the Second Affiliated Hospital of Fujian Medical University,including 36 cases of ileal conduit group and 35 cases of cutaneous ureterostomy group(including 15 cases of MCU group and 20 cases of TCU group).The general data,clinical data,health-related quality of life score,postoperative short-term and long-term complications are compared between the two groups.We further compare the postoperative complications between the MCU group and TCU group.Results: There is no significant difference in the male ratio,BMI,preoperative serum creatinine,albumin,hemoglobin,laparoscopic operation ratio,and the mean age during operation between the two groups.The proportion of ASA ≥ 3 and clinical stage ≥ T3 in the group of CU is higher than that in the group of IC.The differences of operation time,hospitalization time,getting out of bed time and eating time are statistically significant,and the IC group had obvious advantage.Comparing the incidence of shortterm complications,in CU group,the incidences of intestinal dysfunction,incision infection and anastomotic leakage are significantly higher than those of IC group.With the development of long-term complications,in CU group,stricture,damage of renal function,hydronephrosis and dilation of ureter are significantly higher than those of IC group,but the proportion of re-admission of intestinal obstruction is lower.Last but not least,there is no significant difference in FACT-BL between the two groups.In a further comparison,we find that there is no significant difference in general data and clinical data between MCU group and TCU group,but the rate of stricture,dermatitis around the stoma and the rate of readmission are lower,and catheter-free rate is higher,and the cost of stoma nursing is lower in the former group.Conclusion: The overalll quality of life after CU is the same as that after IC operation.However,CU has simple operation,rapid recovery and low incidence of short-term complications.It is especially suitable for the patients who are elderly,weak,poor in general condition and not suitable for complicated and high-risk operation.In addition,the MCU has better clinical value,such as low incidence of stoma stenosis,high catheter-free rate,better drainage effect,easy nursing,low nursing cost and so on.So it is worth popularizing.It is advanced,practical and innovative in clinical practice,but it still needs follow-up and analysis of large cases.