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[Bladder replacements controlled by the anal sphincters: modified rectal bladder]

M A Ghoneim1

  • 1Centro di Urologia e Nefrologia, Università di Mansoura, Egitto.

Chirurgia Italiana
|January 1, 1997
PubMed
Summary
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This study introduces a novel double-folded rectosigmoid pouch for urinary diversion, aiming to resolve issues like obstructions and enuresis seen with previous techniques. The improved technique offers better continence and urodynamics, though metabolic acidosis remains a consideration.

Area of Science:

  • Urology
  • Surgical Innovation
  • Gastrointestinal Surgery

Context:

  • Ureterosigmoidostomy with a submucosal tunnel presents challenges including anastomotic obstructions, nocturnal enuresis, metabolic acidosis, and tumorogenesis.
  • Existing urinary diversion techniques often struggle with reflux, strictures, and inadequate reservoir capacity.

Purpose:

  • To present a novel surgical procedure, the double-folded rectosigmoid pouch, designed to overcome the limitations of previous urinary diversion methods.
  • To detail the anti-reflux mechanisms and improved urodynamic features of the new pouch, including ureteric implantation and rectal patching with ileum.

Summary:

  • The double-folded rectosigmoid pouch procedure incorporates a colo-rectal valve and an anti-reflux ureteric implantation technique.
  • A second intussusception valve is utilized to prevent reflux and minimize strictures, addressing issues with dilated ureters.

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  • The technique enhances reservoir capacity, compliance, and nighttime continence, offering a simpler, staple-free alternative.

    • Impact:

    • Potential to reduce complications associated with traditional ureterosigmoidostomy, improving patient quality of life.
    • Addresses challenges of reflux and strictures in urinary diversion, offering a more robust anti-reflux mechanism.
    • Highlights the need for continued monitoring for metabolic acidosis and potential carcinogenesis, with NSAIDs suggested for prevention.