The intestinoprostatic capsule anastomosis: functional and anatomic results in a canine model

Because of its potential application to intestinal bladder reconstructions, the authors studied the functional and anatomic results of a modification of the Camey procedure. In this modification the enteric bladder replacement is sutured to the periphery of the prostatic capsule after the inner two-thirds of the prostate gland have been removed. In eight dogs postoperative functional studies revealed that all were continent and potent. Autopsy examination of the area of the intestinoprostatic anastomosis revealed that the prostatic fossa was lined by a transitional epithelial layer originating from the urethral stump and not by intestinal mucosa as might be expected. The results indicated that this modification is simpler technically than the original procedure, that it shortens the operating time and that it gives excellent functional results. If used in the context of bladder cancer, however, the procedure should be undertaken only in the presence of negative biopsies and brushings of the urethra before surgery, because the transitional epithelium lining the prostatic fossa represents a new area at risk later malignant transformation. Moreover, because of the potential importance of the area of prostatic fossa resurfaced postoperatively by urothelium, even patients with normal preoperative urethral biopsies and brushings who undergo such a procedure require careful follow-up with endoscopic examination, urethral biopsy and brushings and cytologic examination of the urine.