A technique for total substitution of the lower urinary tract without the use of a prosthesis

A technique is described for total replacement of the lower urinary tract in women in which a pedicled labial skin tube is created and anastomosed to a substitution cystoplasty with a submucosal tunnelled type of "anti-reflux" anastomosis which provides a continence mechanism. The patients thereafter void by intermittent self-catheterisation. This technique has been used in 6 women as part of total pelvic reconstruction for vesico-vagino-rectal fistula following radical radiotherapy, with or without a Wertheim's hysterectomy, for carcinoma of the cervix. A similar technique using a pedicled preputial/penile skin tube has been used in 2 men following a cystoprostato-urethrectomy for transitional cell carcinoma of the bladder.