[Bladder replacements controlled by the anal sphincters: modified rectal bladder].

The procedure was designed to overcome some problems seen with uterosigmoidostomy (with a submucosal tunnel), namely obstructions at the anastomotic site, nocturnal enuresis, metabolic acidosis and tumorogenesis. A colo-rectal valve isolates the rectal bladder to prevent regurgitation of urine, an anti-reflux technique is used for ureteric implantation and the rectum is patched with ileum to improve urodynamics and provide better compliance and continence, particularly at night. A second intussusception valve creates zero reflux and extremely low strictures, while also solving problems with dilated ureters. The double-folded rectosigmoid pouch has several advantages: it is a relatively simple procedure requiring no staples, it produces an anti-reflux mechanism suitable for normal or dilated ureters and provides a high-capacity reservoir. It does, however, create metabolic acidosis, and there is the possibility of future carcinogenesis, which may be prevented if NSAIDs are given.