Low Chimney Cutaneous Ureterostomy (LCCU): a novel technique for supra-vesical urinary diversion

Supra-vesical urinary diversion is rarely needed in current pediatric urology practice. Developments in reconstructive surgery, pediatric endoscopy, and anesthesia have promoted early definitive management of majority of indicated congenital obstructive uropathies. Ureterostomy is an effective alternative for decompressing upper urinary tract; however, none of current techniques provide an optimal diversion. End ureterostomy (EU) and low-loop ureterostomy (LLU) do not allow urinary bladder cycling especially in bilateral cases and those with solitary kidneys. EU cannot drain the urinary bladder with a refluxing ureter. Sober’s ureterostomy allows immediate elimination of high intrarenal pressure together with urinary bladder cycling; however, it is inconvenient for family in care, and closure requires another separate procedure. Herein, we evaluate feasibility, efficacy, and complications of low chimney cutaneous ureterostomy (LCCU) as a new supra-vesical urinary diversion procedure. After obtaining ethical approval (IRB No. 00012098), data from 11 patients who underwent cutaneous ureterostomy (CU) for 13 ureters using this technique between 2008 and 2023 were collected and reviewed retrospectively. Indications for LCCU were ureterovesical junction obstruction (UVJO) or high-grade vesicoureteral reflux (VUR) with dilatation either primary or secondary to bladder outlet obstruction. Reversal of LCCU was performed in seven patients with nine ureters, together with ureteral reimplantation through the same incision. All patients showed improvement in the upper urinary tract following diversion. Reversal of LCCU was performed after a median time of 13 months (6-22) with maintained improvement of the upper urinary tract. LCCU is a safe method for supra-vesical urinary diversion with satisfactory results. This technique maintains the blood supply to the lower ureteral segment and the surgical field intact for the definitive procedure. The location of the stoma makes its care easy for the family and enables its reversal with ureteral reimplantation using a single incision.