[Comparative evaluation of different methods of urine derivation after cystectomy for bladder cancer]

Various methods of urine derivation in the patients with carcinoma of the urinary bladder who had undergone cystectomy were comparatively analysed. To solve the problem the authors performed 87 surgeries with the use of ureterostomy (44); isolated ileac segment--Bricker's method--(12); rectoplastic formation of the bladder (11); isolated sigmoid segment (10); ureterosigmoidostomy (10). Various degrees of urine retention before the operation (ureteropyeloectasia, ureterouronephrosis, renal failure) occurred in 39 patients exposed to ureterostomy, 10 patients subjected to the surgery by Bricker's technique, in 4 subjects who underwent the rectoplastic formation of the bladder, 2 patients who sustained ureterosigmoidostomy and 5 ones with isolated sigmoid segment. 15 patients (17.2 per cent) died in the postoperative period. The highest percentage of lethal outcomes was recorded in those who sustained ureterosigmoidostomy (50) or rectoplastic formation of the bladder (27.2), the lowest, in the patients with isolated ileac segment (8.2). Peritonitis (5) and pyelonephritis (3) were the main causes of death. Associated complications of the upper urinary tract, such as pyelonephritis attacks or renal failures, were more common in those who sustained ureteroneoileostomy (4) or ureterosigmoidostomy (9), while in case of Bricker's technique application it occurred but once. The authors considered ureteroneoileostomy (the technique by Bricker) as the most optimal modality correcting the urine derivation regardless of the severity of the upper urinary tract changes.