A SIMPLE TECHNIQUE FOR URINARY-DIVERSION - THE DISMEMBERED DETUBULARIZED RECTOSIGMOID BLADDER WITH DISTAL COLORECTOSTOMY

Purpose: A new modification for urinary diversion following cystectomy is presented. Materials and Methods: A total of 20 patients with blad der cancer who were treated with radical cystectomy underwent urinary diversion using a new technique. The sigmoid colon is dismembered appr oximately 30 cm. proximal to the peritoneal reflection and detubulariz ed by anterior incision in its proximal two-thirds. Ureters are reimpl anted by nipple or submucosal tunnel technique. The rectosigmoid sheet is folded on itself and closed to form a rectosigmoid pouch. The term inal colon is reanastomosed end to side to the anterior surface of the rectum just proximal to the peritoneal reflection. Results: During 4 to 36 months of followup all patients had complete daytime continence and only 2 had minimal nighttime fecal incontinence. The average dayti me and nighttime evacuation frequency;was 6 and 2 times, respectively. All patients were able to withhold voiding for an average of 30 minut es after maximum desire to void. Eight patients voided clear urine sep arated from stools in most instances while 12 voided mixtures of urine and stools. Postoperative excretory urogram revealed improvement of p reviously dilated systems in 8 renal units, deterioration in 4 and sta ble renal morphology in 28. An ascending pouchogram demonstrated good filling capacity in all cases. Urodynamic studies revealed low basic p ressure within the pouch (mean 9.7 +/- 1.8 cm. water) with high compli ance (mean 32.3 +/- 10). Conclusions: This type of diversion provides a low pressure urine reservoir with satisfactory early results of pres ervation of the upper urinary tract and evacuation pattern.