CONTINENT URINARY-DIVERSION AND DIVERTING COLOSTOMY IN THE THERAPY OFNONHEALING PRESSURE SORES IN PARAPLEGIC PATIENTS

Immobilization and subsequent sacral decubitus or pressure sore format ion is a danger faced by the paraplegic. We report on 4 patients treat ed with non-healing pressure sores. Three male patients had decubiti e roding into the posterior urethra and bladder neck area. One female pa tient had bladder neck and urethral loss secondary to Foley catheter e rosion and a sacral pressure sore. All 4 had non-healing decubiti seco ndary to urinary contamination and, in addition, gross fecal contamina tion in the male patients. All patients failed previous muscular flaps and urinary diversion per suprapubic tube. In the male patients, supr apubic continent urinary diversion included bladder neck mobilization, closure of the distal urethra by oversewing and patching with bovine dura, and augmentation of the bladder with a Miami pouch. Fecal divers ion was provided with a sigmoid colostomy. In the female patient, cont inent diversion was performed by forming a Miami pouch. Total diversio n allowed healing of the pressure sores and provided a simpler method of personal hygiene. Details of the diversion and case studies will be presented.