Cutaneous ureterostomy as palliative diversion in adults with malignancy.

Over a twenty-one-year period (1963-1984) 46 patients underwent a permanent urinary diversion using cutaneous ureterostomy. Thirty-seven of these patients had this method of diversion employed as palliation for pelvic malignancies. In 70 per cent of the patients diversion was done secondary to ureteral obstruction and in the other patients because of either severe lower urinary tract symptoms or a failed alternate form of diversion. Forty-nine per cent of the patients experienced a postoperative complication. The late postoperative complications were either related to the choice of diversion or presumed progression of the patient's disease. Palliative diversion is now best initially attempted with percutaneous nephrostomy or indwelling ureteral stents if bladder function allows. Cutaneous ureterostomy no longer is indicated as a primary form of palliative diversion, however, it may be used as an alternative to open nephrostomy tube placement or intestinal conduit should other more conservative forms of management fail. The presence of at least one dilated ureter is a prerequisite to the success of this form of diversion.