DOUBLE FOLDED RECTOSIGMOID BLADDER WITH A NEW URETEROCOLIC ANTIREFLUXTECHNIQUE

Purpose: We present a new method of urinary diversion to the rectum. M aterials and Methods: Between 1992 and 1995 a new surgical procedure w as used in 32 women, 20 men and 12 children 3 to 60 years old (mean ag e plus or minus standard deviation 35.4 +/- 2.2). The main indication for diversion was invasive bladder carcinoma. Surgery entailed creatio n of an S-shaped double folded rectosigmoid reservoir with implantatio n of the ureters via an extramural serous lined antireflux technique. Results: One patient died of a massive pulmonary embolism postoperativ ely. Followup ranged from 6 to 36 months (mean 19.2 +/- 7.0). During t he observation period 6 patients died of local recurrence and/or dista nt metastasis within 8 months. Of the patients 57 are currently evalua ble. All patients are continent during the day with an emptying freque ncy of 2 to 4 times. Nocturnal enuresis was observed in 4 children who responded favorably to imipramine hydrochloride therapy. Upper urinar y tract function was maintained or improved in 95% of the patients. No clinical evidence of acidosis was observed, since all patients were k ept on prophylactic oral alkalization. Conclusions: The procedure can circumvent some of the inherent disadvantages of ureterosigmoidostomy and is a good alternative to orthotopic bladder substitution when the urethra cannot be used.