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Rectosigmoidal bladder utilizing intussuscepted ileal segment: A surgical technique for urinary diversion and experiences in 30 patients
Author(s) -
OHYAMA CHIKARA,
TSUCHIYA NORIHIKO,
HABUCHI TOMONORI,
SATO KAZUNARI,
SATOH SHIGERU,
SHIMODA NAOTAKE,
KATO TETSURO
Publication year - 2004
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/j.1442-2042.2004.00820.x
Subject(s) - medicine , urinary diversion , rectum , pouch , urinary bladder , reflux , surgery , urinary system , urethra , urology , bladder stone , urinary continence , ileocecal valve , cystectomy , ileum , prostate , bladder cancer , disease , cancer , prostatectomy
Background: We previously reported that the ileocecal rectal bladder consists of interposition of an intussuscepted ileocecal segment between the ureters and the rectum for those in whom the urethra is not available. Although the ileocecal rectal bladder has been well accepted by most patients, it requires an extensive preparation along the ascending colon. We present a modified operation technique (rectosigmoidal bladder) by using the ileal segment alone as an interposing antireflux component and by using the sigmoidal segment to augment the rectal capacity. Methods: From February 1993 to July 2002, 30 patients with a median age of 64 years underwent construction of a rectosigmoidal bladder. Median follow‐up period was 26 months (range, 13–125). The follow up was carried out using clinical and functional assessments such as evacuation status, serum chemistry and radiographic evaluation of the upper urinary tracts and rectosigmoidal pouch. To assess the postoperative health‐related quality of life, we carried out a survey comparison of the ileocecal rectal bladder patients and the rectosigmoidal bladder patients. Results: No operative or urinary diversion‐related postoperative mortality was encountered. All rectosigmoidal bladders had sufficient capacity, with no evidence of urinary reflux or daytime incontinence. When compared with our previous procedure, the ileocecal rectal bladder, the present procedure had advantages with respect to complications with urine‐fecal leak and acidosis. There were no differences in mean operation time, or in the health‐related quality of life survey, between the two procedures. Conclusions: Our experience showed that this technique should be considered for those in whom the urethra is not available.