[Distal detubularized sigmoidoplasty. Description of the technique]

To describe a new technique for orthotopic bladder replacement using a short detubularized segment of the most distal portion of the sigmoid colon, termed "detubularized distal sigmoidoplasty'.

The surgical technique utilized 1) large bowel to provide a larger intestinal lumen, stronger muscle layer and minimum metabolic activity; 2) a short segment providing adequate volume in the sigmoid and a reduced surface of exchange; and 3) a distal segment close to the urethra so it can be easily advanced without stretching and with minimum sectioning of the mesosigmoid. A short segment (approximately 18 cms) of the distal sigmoid is separated with minimum mobilization of the mesentery. It is detubularized to obtain a centrally located rectangle. The ureter is reattached using the antireflux technique of direct retrograde submucosal tunneling with a symmetrical pseudotrigonal arrangement. The reservoir is constructed using a single transverse continuous suture that is interrupted 2 cms before complete closure of the neobladder to provide an orifice for urethral anastomosis.

The technique is simple and utilizes a segment shorter than those described to date. Any segment of the sigmoid can be utilized. The neobladder can be shaped with a single continuous suture and the ureter can be reinserted in a more anatomic position. The reservoir has an adequate volume of approximately 300 cc. Voiding is accomplished by contraction of the reservoir and abdominal pressure.

This neobladder technique is simple. It achieves excellent diurnal continence and maintains the contractile capacity which permits comfortable and compensated voiding.