A low-pressure rectosigmoid pouch created by side-to-side anastomosis with a stapling technique and sigmoid colon intussusception as an antireflux procedure.

OBJECTIVE

To assess a new procedure of urinary diversion after cystectomy for bladder cancer.

PATIENTS AND

METHODS

Thirty-two patients (14 women and 18 men, mean age 54 years, range 35-70) treated by radical cystectomy for bladder cancer underwent urinary diversion using a new technique. 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 implantation of the ureters between the layers of the intussusceptum. Two ureteric stents (8F) were brought out through the iliac fossa, and a rectal tube introduced through the anus and the intussusception to the proximal colon. The reservoir was assessed by urodynamic studies, using the anorectal perfusion catheter.

RESULTS

Twenty-eight patients were continent day and night, with mild soiling in the remaining four at night. Complications included a urinary fistula in three patients and a fecal fistula in one; all were treated conservatively. Metabolic complications occurred in only two patients.

CONCLUSION

The pouch created has a low pressure, a high capacity and provides effective continence. Surgery remains adequately radical, by removing the prostate and the membranous urethra. The implanted ureters between the layers of the intussusceptum provided an effective antireflux mechanism and markedly improved kidney function. The intussusception prevents reflux of the pouch contents into the proximal colon and minimizes metabolic complications. The technique needs neither colostomy nor small intestinal manipulations.