OBJECTIVE: To assess the surgical method and results at 3 months of ureterosigmoidostomy modified by reconfiguration of the rectum to make a low-pressure reservoir. PATIENTS AND METHODS: Over the last 8 years, patients undergoing lower urinary tract reconstruction have been followed using a written protocol; the data from patients undergoing a modified ureterosigmoidostomy were retrieved for a retrospective analysis. Two groups of patients were defined: in group A, 15 patients underwent cystectomy and diversion by modified ureterosigmoidostomy and in group B, four patients already had a conventional ureterosigmoidostomy which was incontinent, and the rectum was reconfigured to improve control. The incidence of complications and causes of incontinence were assessed. RESULTS: The rectum was reconfigured by longitudinal incision and transverse closure in a 'U' fashion (Mainz II) in 17 patients, and augmented with ileum in two. There were no surgical complications. In group A all patients were continent at 3 months and in group B only two of four were continent; one patient in group A subsequently became incontinent. All incontinence was caused by chronic retention and overflow. There were no cases of pyelonephritis during follow-up to 29 months and no ureteric reflux was detected. CONCLUSIONS: Modified ureterosigmoidostomy is a safe method of urinary diversion after cystectomy. A longer follow-up is needed to judge its place compared with other forms of diversion. It has a limited place in the management of incontinence in those with a longstanding conventional ureterosigmoidostomy.
OBJECTIVE: To assess the surgical method and results at 3 months of ureterosigmoidostomy modified by reconfiguration of the rectum to make a low-pressure reservoir. PATIENTS AND METHODS: Over the last 8 years, patients undergoing lower urinary tract reconstruction have been followed using a written protocol; the data from patients undergoing a modified ureterosigmoidostomy were retrieved for a retrospective analysis. Two groups of patients were defined: in group A, 15 patients underwent cystectomy and diversion by modified ureterosigmoidostomy and in group B, four patients already had a conventional ureterosigmoidostomy which was incontinent, and the rectum was reconfigured to improve control. The incidence of complications and causes of incontinence were assessed. RESULTS: The rectum was reconfigured by longitudinal incision and transverse closure in a 'U' fashion (Mainz II) in 17 patients, and augmented with ileum in two. There were no surgical complications. In group A all patients were continent at 3 months and in group B only two of four were continent; one patient in group A subsequently became incontinent. All incontinence was caused by chronic retention and overflow. There were no cases of pyelonephritis during follow-up to 29 months and no ureteric reflux was detected. CONCLUSIONS: Modified ureterosigmoidostomy is a safe method of urinary diversion after cystectomy. A longer follow-up is needed to judge its place compared with other forms of diversion. It has a limited place in the management of incontinence in those with a longstanding conventional ureterosigmoidostomy.
Authors: P J Bastian; P Albers; H Hanitzsch; G Fabrizi; R Casadei; A Haferkamp; S Schumacher; S C Müller Journal: Urologe A Date: 2004-08 Impact factor: 0.639