A Case of Ureteroileocecal Sigmoidostomy with Sigmoid J Pouch / 대한비뇨기과학회지

We performed a case of ureteroileocecal sigmoidostomy in a 56-year-old female patient who had transitional cell carcinoma of the bladder(pT3aNoMo, grade III, mutiple, papillary). Both ureters were anastomosed to the ileal end of the ileocecal segment and colonic end was anastomosed to the J pouch of the sigmoid colon. At 7 months postoperatively, the intraluminal pressure of the pouch is 20 cmH2O in supine position, 40 cmH2O in sitting or squatting position, 90-100 cmH2O on voiding. No visible reflux of fecal and urinary stream into upper urinary tract was observed on both antegrade and retrograde pouchgraphy. No ectatic changes of upper urinary tract was seen on excretory urography until 36 months postoperatively. There was no changes in CBC, liver function, renal function and serum electrolytes. Even though there had been no febrile attack without any antibiotic medications during follow-up period, bilateral renal scarring was observed on CT films of postoperative 24 months. Continuous suppressive dose of sulfamethoxazole- trimethoprim was started. She passes urine in diarrhea pattern every three to four hours and has no leakage in night time. She satisfies with status of voiding at present after 30 months postoperatively. No visible reflux into upper urinary tract from the pouch is identified, ascending infection could not be prevented by this antireflux method only. This procedure can be an alternative way of urinary diversion in the era of bladder substitution if ascending infection can be prevented by enforced and more secure procedures to prevent reflux are added.

Clinical Evaluation and Experience of Ureterosigmoidostomy / 대한비뇨기과학회지

A clinical observation on 11 cases of ureterosigmoidostomy was made on whom had been operated at the department of Urology from January, 1985 to February, 1995. Underlying diseases at the time of operation were 9 cases of bladder cancer, 1 case of prostatic cancer and 1 case of urethrovesicovaginal fistula. In postoperative care,all patients were instructed to empty the rectum frequently, and took bicarbonate and potassium supplementation for electrolyte balance. Use of combined method with antireflux seems to lower the incidence of reflux, pyelonephritis and anastomotic site stricture. This way of diversion supplies a substitute bladder under voluntary control, devoid of any foreign body, appliance, or necessity of catheterization. We believe that ureterosigmoidostomy should not be overlooked and should be convenient alternative in well selected patients who have intact anal sphincter tone and desire a continent form of internal diversion with normal body shape.

Ileocecal Ureterosigmoidostomy: A Case Report / 대한비뇨기과학회지

Recently, continent internal urinary diversion has begun to achieve worldwide popularity. Herein, we report an experience with a 5 year-old female patient who had total urinary incontinence due to left ectopic ureter and vesicourethrovaginal fistula. The ileocecal ureterosigmoidostomy was performed as a staged procedure. The ileocecal segment including a part of ascending colon was isolated, an intussusception through the ileocecal valve was performed as the antireflux mechanism, and the ureters were spatulated and anastomosed side to side. The combined ureters then were sewn end to end to the ileum and the cecum was brought out on the skin as a stoma. Eleven months after first operation, the cecal stoma was taken down and discarded, and the remaining cecum containing the antireflux intussusception was anastomosed end to side to the lower sigmoid, internalizing the urinary diversion. After operation, she has gained perfect urinary control with no evidence of reflux, urinary tract infection and electrolyte imbalance for the 5 years follow up period. In conclusion, ileocecal ureterosigmoidostomy is a reasonable alternative to conventional ureterosigmoidostomy that may reduce the risk of development of cancer.

A method of preventing reflux of intestinal contents into urinary tract using roux-en-Y ileosigmoidostomy with rectosigmiod pouch / 대한비뇨기과학회지

Roux-en-Y ileosigmoidostomy with or without rectosigmoid pouch was done to know how these prevent the reflux of intestinal contents into the urinary tract. Twenty one New Zealand white rabbits were divided into three groups, Group t of Roux-en-Y ileosigmoidostomy, Group II of Roux-en -Y ileosigmoidostomy and end to side rectosigmoidostomy 5cm distal to the ileosigmoidostomy site, and Group III, same as Group II with the distance of 10cm. Direction of stream of bowel contents. frequency of peristalsis and pressure of bowel segments were observed with fluoroscopy and urodynamic evaluation. When the contrast media were infused through proximal sigmoid, reflux of contrast media from colon to ileum was occurred least frequently (14.3 %) in Group III. When the contrast media were infused through the ileal segment of Roux-en-Y, reflux of contrast media from ileum to the proximal sigmoid colon was occurred least frequently (28.6 %) in Group III. These observations show double Roux-en-Y ileosigmoidostomy with rectosigmoidostomy is one of effective mechanism to prevent reflux of fecal stream from urinary tract. The optimal distance between ileosigmoidostomy and rectosigmoidostomy sites will be a major factor to exert the maximum antireflux effect.

Clinical Significance of Ureterosigmoidostomy in Urinary Diversion / 대한비뇨기과학회지

Many urologists began to abandon ureterosigmoidostomy as the preferred method of diversion nearly 35 years ago when Bricker described the ileal conduit. The complications were instrumental in dissuading many urologist. A clinical observation on 14 cases of ureterosigmoidostomy was made on who had been admitted to the Department of urology from January, 1976 to march, 1985. Use of the combined procedure seems to minimize the incidence of pyelonephritis, and the incidence of hypercchloremic acidosis as a long-term complication appears to be an acceptable problem. Ureterosigmoidostomy should be considered more frequently as the method of urinary diversion.

A Clinical Study on Urinary Diversion and Reconstruction of the Urinary Tract with the Intestine / 대한비뇨기과학회지

In the field of urological surgery, the use of bowel has been established as methods of urinary diversion or reconstruction of urinary tract since ileal conduit was settled by Bricker in 1950. Urinary diversion or reconstruction with use of bowel segment is usually performed for the purposes of life saving and social adaptation of patients by removal of tumor itself and by preservation of renal function and normal urination. A favorable prognosis can be expected by urinary diversion utilizing a intestinal segment after removal of bladder and its surrounding tissues for the therapy of bladder carcinoma. In Korea, where tuberculosis is prevailing, interests of many urologists are centered on the preservation of bladder capacity for the treatment of contracted bladder complicating tuberculosis of urinary tract. But until recently, only a few experimental or clinical studies on urinary diversion and reconstructs on with use of the intestinal segment were reported in this country. A clinical observation was made on I7 cases of urinary diversion or reconstruction with use of the intestinal segment, which were performed on the patients admitted to the Department of Urology, Severance Hospital in 1977. The results are as follows: 1. The age distribution of patients was from 4th, to 6th. decades. 2. Among the patients, 13 cases were male and 4 cases were female bladder tumor were male. 3. The patients were consisted of 11 cases of bladder tumor, 5 cases of tuberculous contracted bladder and 1 case of a large vesicovaginal fistula 4. In operations, ileal conduit for 11 cases of bladder tumor, ileocystoplasty for 5 cases of tuberculous contracted bladder and ureterosigmoidostomy for 1 case of a large vesicovaginal fistula were performed. Acccmpanyingileal conduit, total cystectomy was performed in 10 cases end ligation of biateral hypogastric arteries only in the rest.5. In bladder tumor, comparing with pathological staging, the number of clinical understating and overstaging were 5 and 2 cases respectively. The pathological stages were not significantly correlated with the grades. 6. After ileocystoplasty for tuberculous contracted bladder, the intervals of urination was prolonged to 2 hours or more and improvement of incontinence was noted in all cases. 7. The blood levels of urea nitrogen and creatinine returned to normal except 1 case complicated with infection of urinary tract after operation. 8. The mean volumes of transfused blood during operation were 1,026ml for ileal conduit with total cystectomy, and 664ml for ileocystoplasty. The mean operation time was 5 hours and 56 minutes for ileal conduit with total cystectomy and 5 hours and 12 minutes for ileocystoplasty 10. The average postoperative duration were 18 days in ileal conduit with total cystectomy and 17 days in ileocystoplasty. 11. The postoperative complications included 5 cases of wound infection, 5 cases of urinary tract infection, 3 cases of paralytic ileus or mechanical ileus and 2 cases of urine leak.

Clinical Observation of the Ureterosigmoidostomy / 대한비뇨기과학회지

Clinical observation was made on 11 cases of ureterosigmoidostomy during the period from 1959 to 1976. Age ranged from 27 to 65 years and 7 female and 4 male each. Underlying diseases at the time of operation were 6 cases of vesico-vaginal fistula and 5 cases of bladder tumor. Their operation time, amount of transfusion, electrolyte balance, early and late complications after operation were analyzed. It seemed to us that despite the many urologist abandon ureterosigmoidostomy and prefer ileal diversion, its usefulness is assessed in our paper and applicable to some selected patients.

Experiences of Ureterosigmoidostomy with Sigmoid Pouch / 대한비뇨기과학회지

The author had experienced 3 cases of ureterosigmoidostomy with sigmoid pouch and colostomy above as urinary diversion after total cystectomy in patients having advanced bladder carcinoma. The postoperative complications such as electrolyte imbalance, infection or hydronephrosis were not remarkable in these cases, which have been frequently encountered in ureterosigmoidostomy alone. The patients had been well in urination without significant frequency, residual urine or incontinence.