Margit Fisch, MD, FEAPU, FEBU, presented “Ureterocutaneostomy: A Valuable Option for Urinary Diversion in the Elderly Patient?” during the 40th Annual Ralph E. Hopkins Urology Seminar on February 5th, 2020 in Jackson Hole, Wyoming.
How to cite: Fisch, Margit. “Ureterocutaneostomy: A Valuable Option for Urinary Diversion in the Elderly Patient?” February 5th, 2020. Accessed Nov 2024. https://grandroundsinurology.com/ureterocutaneostomy-a-valuable-option-for-urinary-diversion-in-the-elderly-patient/
Ureterocutaneostomy: A Valuable Option for Urinary Diversion in the Elderly Patient? – Summary:
Margit Fisch, MD, FEAPU, FEBU, Director and Chair of the Department of Urology and Pediatric Urology at University Medical Center Hamburg-Eppendorf in Hamburg, Germany, discusses the value of ureterocutaneostomy as a urinary diversion technique for the increasing number of older, sicker patients with urothelial carcinoma of the bladder. Dr. Fisch explains that, compared with other urinary diversions, ureterocutaneostomy is a simpler, shorter procedure with no significant quality of life differences. She then summarizes the findings of a cystectomy series, which showed that even though patients who had undergone ureterocutaneostomy were older, more likely to have comorbidities, and more likely to have had prior pelvic/abdominal surgeries and irradiation compared with patients who had received ilial/colonic conduit or continent diversion, they had the shortest surgeries and hospital stays during cystectomy, as well as no difference in 30-day complication rate. The benefits of ureterocutaneostomy are further corroborated by a study which compared ureterocutaneostomy to urinary diversion with use of bowel, and found that ureterocutaneostomy patients had shorter operating room time, shorter time in the ICU, and fewer serious complications, although they did experience higher long-term morbidity, probably because of comorbidities. Dr. Fisch notes that ureterocutaneostomy has late complications such as abscess formation, ureteral necrosis, stoma stenosis, and pyelonephritis, but concludes that conduits are no better in this area, and that the benefits of ureterocutaneostomy make it a valuable and useful diversion in elderly patients.
About The 40th Annual Ralph E. Hopkins Urology Seminar:
The Ralph E. Hopkins Urology Seminar is a multi-day meeting focused on training urologists in the latest in assessing, diagnosing, and treating urologic conditions in the clinical setting. Updates are provided on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. Dr. Fisch presented this lecture during the 40th iteration of the meeting on February 5th, 2020 in Jackson Hole, Wyoming.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Margit Fisch, MD, FEAPU, FEBU, is Director of the Department of Urology and Pediatric Urology of the University Medical Center Hamburg-Eppendorf. Her major professional interest is reconstructive urology, especially urethral reconstruction and urinary diversion. In cooperation with the Center of Urology and Nephrology in Mansoura, Egypt, she contributed major advances to ureteral implantation and urinary diversion using the anal sphincter, including developing and publishing the “sigma-rectum pouch” technique. In cooperation with the University College in Dublin, Ireland, and Prof. John Fitzpatrick, she created the “transverse colonic pouch” technique, among others.
Dr. Fisch trained with Professor Rudolf Hohenfellner and Joachim W. Thüroff in Mainz, Germany. In 2000 she moved to Hamburg to become Head of the Section of Pediatric Urology at the Asklepios Clinic and became Director of the Department of Urology and Pediatric Urology in 2002. She has held her University of Hamburg position since December 2008. Dr. Fisch is Fellow of the European Board of Urology (FEBU) and the European Academy of Paediatric Urology (FEAPU). She is an elected International Member of the American Association of Genitourinary Surgeons (AAGUS) and the Society of Pelvic Surgeons (SPS). She is a member of the Association of Academic European Urologists (AAEU). She has served as President of the Society of Genito-Urinary Surgeons (GURS) and the European Society of Genito-Urinary Surgeons (ESGURS) and was the first female President of the German Association of Urology (2021 – 2022). Memberships include the European Association of Paediatric Urology (ESPU), Society of Pediatric Urologic Surgeons (SPUS), the European Association of Urology (EAU), the American Association of Urology (AUA), the German Association of Urology (DGU) and the German-Japanese Confederation of Urology. Dr. Fisch has published over 300 papers and book chapters, with over 90 as first author, and she organizes the International Meeting on Reconstructive Urology (IMORU).
Dr. Fisch trained with Professor Rudolf Hohenfellner and Joachim W. Thüroff in Mainz, Germany, and became a staff member at Mainz Medical School in 1992. She served as Vice-Chair of the Department of Urology before moving to Hamburg to become Head of the Section of Pediatric Urology at the Asklepios Clinic in 2000. In 2002, she became Director of the Department of Urology and Pediatric Urology. She has held her University of Hamburg position since December 2008.
Dr. Fisch is Fellow of the European Board of Urology (FEBU) and the European Academy of Paediatric Urology (FEAPU). Additionally, she is Adjunct Scientific Chair and Board Member of the Société Internationale d’Urologie (SIU), and an elected International Member of both the American Association of Genitourinary Surgeons (AAGUS) and the Society of Pelvic Surgeons (SPS). She has served as President of the Society of Genito-Urinary Surgeons (GURS) and the European Society of Genito-Urinary Surgeons (ESGURS).
Memberships include the European Association of Paediatric Urology (ESPU), the American Academy of Pediatrics (AAP), the Society of Pediatric Urologic Surgeons (SPUS), the European Association of Urology (EAU), the American Association of Urology (AUA), the German Association of Urology (DGU), the Panafrican Association of Urology (PAUSA), and the German-Japanese Confederation of Urology.
She has published >300 papers and book chapters, with >90 as first author, and organizes the tri-annual International Meeting on Reconstructive Urology (IMORU).
