Rectal bladder with dorsolateral, intrasphincteric submucosal pul through of the sigmoid colon in adult bladder cancer patients. Five years later.

Report on 12 adult bladder tumor patients with cystectomy, rectal bladder and dorsolateral, intrasphincteric pull through of the sigmoid and anal colostomy (Nédélec type). Voluntary control of feces and urine was found satisfactory by most patients although urinary continence at night was not perfect. The long-term prognosis with this form of urinary diversion in patients with bladder cancer was far from satisfactory: 4 patients died of recurrent carcinoma with terminal symptoms of sepsis, but 5 patients died from primary sepsis (and not cancer) from 3 months to 4 years after diversion. It seems that this bad prognosis was due to insufficient separation of urinary and fecal passage in a group of patients, where the upper urinary tract has often already suffered as the result of earlier tumor treatment. Fewer complications might be expected with an intersphincteric pull through and perineal colostomy (Gersuny type).