Transverse retubularized sigmoidovesicostomy continent urinary diversion to the umbilicus

Purpose: The most widely used conduit when creating continent urinary diver sion based on the Mitrofanoff principle has been appendicovesicostomy. Howe ver, appendix is not always available and it is increasingly used for the a ntegrade continence enema in situ appendix procedure. In 1993 the technique of transverse retubularization of the ileum to create a continent catheter izable conduit for an ileal reservoir was described and in 1997 this techni que was studied in an animal model. Larger patients may need 2 ileal segmen ts in series to bridge the distance between the umbilicus and bladder. To a void using 2 segments we used transverse retubularized sigmoid colon to cre ate a catheterizable sigmoidovesicostomy to the umbilicus. Materials and Methods: In 5 children 6 to 19 years old (mean age 15) with n eurogenic bladder secondary to spina bifida a transverse retubularized sigm oidovesicostomy to the umbilicus was performed. In all patients an antegrad e continence enema procedure was done for refractory constipation and overf low fecal incontinence secondary to neurogenic bowel. Laparoscopy was perfo rmed to mobilize the appendix in patients who requested a low Pfannenstiel incision for better cosmesis. Additional procedures included the pubovagina l sling placement and sigmoid colocystoplasty. Results: Mean length of the sigmoidovesicostomy, which was equal to the cir cumference of the sigmoid before retubularization, was 13 cm. (range 10 to 15). This sigmoid conduit reached the umbilicus easily in all cases. All si gmoidovesicostomies were easily catheterized and all were continent. One pa tient with morbid obesity (body mass index 40.4) had a mucocutaneous anasto motic breakdown 3 months postoperatively. Minimum followup was 1 year (mean 1.5). Conclusions: Transverse retubularized sigmoidovesicostomy is effective for creating a continent urinary diversion to the umbilicus in patients with ne urogenic bladder secondary to spina bifida. Dilating the sigmoid colon from neurogenic bowel creates a long conduit based on the Yang-Monti principle and 2 ileal segments with an anastomosis are not required. Additional benef its are that the sigmoid colon is readily accessible via a low PfannenstieI incision and may also be used for augmentation in select cases.