Archivos espanoles de urologia · 1996
[Distal detubularized sigmoidoplasty. Description of the technique].
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Isorna Martínez de la Riva S
Аннотация
OBJECTIVES: To describe a new technique for orthotopic bladder replacement using a short detubularized segment of the most distal portion of the sigmoid colon, termed "detubularized distal sigmoidoplasty'.
METHODS: The surgical technique utilized 1) large bowel to provide a larger intestinal lumen, stronger muscle layer and minimum metabolic activity; 2) a short segment providing adequate volume in the sigmoid and a reduced surface of exchange; and 3) a distal segment close to the urethra so it can be easily advanced without stretching and with minimum sectioning of the mesosigmoid. A short segment (approximately 18 cms) of the distal sigmoid is separated with minimum mobilization of the mesentery. It is detubularized to obtain a centrally located rectangle. The ureter is reattached using the antireflux technique of direct retrograde submucosal tunneling with a symmetrical pseudotrigonal arrangement. The reservoir is constructed using a single transverse continuous suture that is interrupted 2 cms before complete closure of the neobladder to provide an orifice for urethral anastomosis.
RESULTS: The technique is simple and utilizes a segment shorter than those described to date. Any segment of the sigmoid can be utilized. The neobladder can be shaped with a single continuous suture and the ureter can be reinserted in a more anatomic position. The reservoir has an adequate volume of approximately 300 cc. Voiding is accomplished by contraction of the reservoir and abdominal pressure.
CONCLUSIONS: This neobladder technique is simple. It achieves excellent diurnal continence and maintains the contractile capacity which permits comfortable and compensated voiding.
METHODS: The surgical technique utilized 1) large bowel to provide a larger intestinal lumen, stronger muscle layer and minimum metabolic activity; 2) a short segment providing adequate volume in the sigmoid and a reduced surface of exchange; and 3) a distal segment close to the urethra so it can be easily advanced without stretching and with minimum sectioning of the mesosigmoid. A short segment (approximately 18 cms) of the distal sigmoid is separated with minimum mobilization of the mesentery. It is detubularized to obtain a centrally located rectangle. The ureter is reattached using the antireflux technique of direct retrograde submucosal tunneling with a symmetrical pseudotrigonal arrangement. The reservoir is constructed using a single transverse continuous suture that is interrupted 2 cms before complete closure of the neobladder to provide an orifice for urethral anastomosis.
RESULTS: The technique is simple and utilizes a segment shorter than those described to date. Any segment of the sigmoid can be utilized. The neobladder can be shaped with a single continuous suture and the ureter can be reinserted in a more anatomic position. The reservoir has an adequate volume of approximately 300 cc. Voiding is accomplished by contraction of the reservoir and abdominal pressure.
CONCLUSIONS: This neobladder technique is simple. It achieves excellent diurnal continence and maintains the contractile capacity which permits comfortable and compensated voiding.