Total replacement of the bladder with an intestinal pouch for normal micturition after cystectomy.

Between May 1987 and April 1988, seven male patients aged 43-69 years underwent an operation for total replacement of the bladder with an intestinal pouch for normal micturition after cystectomy. In five, the detubularized ileocecocolic segment was used as the internal reservoir and, in the other two, the ileum or the sigmoid colon was used because of a severe adhesion of the ascending colon due to previous surgery. Three months after surgery, six patients had a vesical capacity of 300 ml or more and could excrete a maximum 200-300 ml urine at one voiding. Daytime continence was achieved in six patients in three months, and night-time continence in five patients in six months. No abnormalities in serum electrolytes, acid-base balance or renal function were observed during follow-up periods of 8-16 months. The patients were enthusiastic about this procedure, including the patient requiring occasional self-catheterization to overcome his incontinence. The follow-up periods have been short, but this method seems promising as a new internal diversion.