Clinical outcomes of a new modified tubeless cutaneous ureterostomy following radical cystectomy

Background: Cutaneous ureterostomy (CU), though a simple urinary diversion (UD), is often limited by stomal stenosis and prolonged stenting-particularly for the contralateral ureter, which is prone to tension-related ischemia. This study introduces a modified CU technique that minimizes exteriorization of the contralateral ureter, aiming to reduce stomal complications and improve the catheter-free rate (CFR), with a focus on its applicability to contralateral ureters. Methods: We conducted a retrospective review of 19 consecutive patients with histologically confirmed bladder cancer (BC) who underwent radical cystectomy (RC) followed by our modified CU technique for UD at our institution between August 2020 and October 2023. Outcomes assessed included the CFR, serum creatinine levels, estimated glomerular filtration rate (eGFR), surgical results, and surgery-related complications. The relationship between achieving tubeless status and clinicopathological factors was also analyzed. Results: A tubeless state was achieved in 35 out of 38 ureters (92.11%; 19 right and 16 left ureters). No stomal stenosis was observed over a median follow-up period of 25 months (range, 8-46 months). No significant correlation was found between tubeless status and clinicopathological factors. Mean serum creatinine levels showed no significant difference between preoperative values, postoperative day 3, and the last follow-up (P=0.46). The eGFR also showed no significant change following surgery (P=0.69). Aside from one patient who underwent percutaneous nephroscopic lithotripsy for a left renal stone, no postoperative complications exceeding Clavien-Dindo grade III were observed. Conclusions: Our modified CU technique is a safe and straightforward procedure associated with a higher CFR compared to other reported modified CU methods. It may be suitable for nearly all ureters as potential candidates for this approach.