A LOW-PRESSURE RECTOSIGMOID POUCH CREATED BY SIDE-TO-SIDE ANASTOMOSISWITH A STAPLING TECHNIQUE AND SIGMOID COLON INTUSSUSCEPTION AS AN ANTIREFLUX PROCEDURE

Objective To assess a new procedure of urinary diversion after cystect omy for bladder cancer. Patients and methods Thirty-two patients (14 w omen and 18 men, mean age 54 years, range 35-70) treated by radical cy stectomy for bladder cancer underwent urinary diversion using a new te chnique. After mobilization of the sigmoid colon, the splenic flexure and the upper rectum, two adjacent colotomies were made to complete a stapled side-to-side anastomosis, with intussusception and implantatio n of the ureters between the layers of the intussusceptum. Two ureteri c stents (8F) were brought out through the iliac fossa, and a rectal t ube introduced through the anus and the intussusception to the proxima l colon. The reservoir was assessed by urodynamic studies, using the a norectal perfusion catheter. Results Twenty-eight patients were contin ent day and night, with mild soiling in the remaining four at night. C omplications included a urinary fistula in three patients and a fecal fistula in one; all were treated conservatively. Metabolic complicatio ns occurred in only two patients. Conclusion The pouch created has a l ow pressure, a high capacity and provides effective continence. Surger y remains adequately radical, by removing the prostate and the membran ous urethra, The implanted ureters between the layers of the intussusc eptum provided an effective antireflux mechanism and markedly improved kidney function. The intussusception prevents reflux of the pouch con tents into the proximal colon and minimizes metabolic complications. T he technique needs neither colostomy nor small intestinal manipulation s.