Purpose: We present a new method of urinary diversion to the rectum.
Materials and methods: Between 1992 and 1995 a new surgical procedure was used in 32 women, 20 men and 12 children 3 to 60 years old (mean age plus or minus standard deviation 35.4 +/- 2.2). The main indication for diversion was invasive bladder carcinoma. Surgery entailed creation of an S-shaped double folded rectosigmoid reservoir with implantation of the ureters via an extramural serous lined antireflux technique.
Results: One patient died of a massive pulmonary embolism postoperatively. Followup ranged from 6 to 36 months (mean 19.2 +/- 7.0). During the observation period 6 patients died of local recurrence and/or distant metastasis within 8 months. Of the patients 57 are currently evaluable. All patients are continent during the day with an emptying frequency of 2 to 4 times. Nocturnal enuresis was observed in 4 children who responded favorably to imipramine hydrochloride therapy. Upper urinary tract function was maintained or improved in 95% of the patients. No clinical evidence of acidosis was observed, since all patients were kept on prophylactic oral alkalization.
Conclusions: The procedure can circumvent some of the inherent disadvantages of ureterosigmoidostomy and is a good alternative to orthotopic bladder substitution when the urethra cannot be used.