[Uretero-rectal diversion with rectal enlargement. Clinical results]

In some patients, after total cystectomy, the urethra cannot be used, preventing the creation of a replacement enterocystoplasty. In these cases, ureterocolonic or ureterorectal diversion constitutes an alternative to cutaneous diversion if its classical complications could be minimized. A ureterorectal diversion technique with rectal enlargement was performed in 6 patients: a segment of small intestine was raised, opened along its antimesenteric border, folded into a U-shape and sutured to the edges of a large rectotomy. The ureters were implanted into this patch of small intestine according to the mucosal tunnel technique. This technique was used in 4 men after total cystectomy with invasion of the prostatic urethra by their bladder tumour and in 2 women for incontinence due to sphincter destruction who refused cutaneous diversion. There was no mortality in this series. The postoperative complications consisted one prolonged but resolving fever in 2 cases. Out of 12 ureteric units, 4 cases of severe stenosis had to be reoperated and 3 cases of moderate stenosis were observed. All patients were continent during the day except for one women who complained of incontinence when changing positions. All patients were continent at night and had to get up to urinate twice. This preliminary experience shows that rectal enlargement as part of a ureterorectal diversion is followed by very satisfactory functional results. The creation of a colorectal invagination valve to prevent metabolic disturbances does not appear to be necessary. The ureteric implantation technique in the mucosal tunnel should be abandoned in favour of a procedure using an ileal tube interposed between the ureters and the rectum.