[Rectocystoplasty in supravesical urinary diversion]

A stepwise development of the technique for the urine derivation into the artificial rectal urinary bladder was followed up. The cutting of the superior rectal artery and the vein which permitted one to form a rectal urinary bladder at the superampullar portion of the rectum turned to be the basic point of the technique development. A beneficial effect was achieved due to the extra-abdominal location of the rectal stump and the performance of ureterorectal anastomosis that minimized the hazards of urinary peritonitis development; the ligature of the superior rectal artery and vein decreased the resorption of the urine; lower mobilization and cutting of the rectum reduced surgery-related traumatism and enabled the surgeon to preserve the part of the sigmoid colon for its descending into the perineum. Based on the comparative evaluation of three modifications of the aforementioned technique, the authors made a conclusion that the derivation of the urine into an artificial rectal urinary bladder minimized the hazards of urinary peritonitis development and the occurrence of ascending pyelonephritis. X-ray and radionuclide investigations revealed recovery of the anatomical and functional status of the upper urinary tract in 75 per cent of the patients during 3-4 mos. The authors revealed insignificant changes in the values of nitrogen-excretory function of the kidney, glomerular filtration and tubular reabsorption in the immediate postsurgery period. Later on, these values approached those documented before the operation.