Experience with continent urinary diversion: Cutaneous stomal and orthotopic reservoirs after radical cystectomy

Several different methods to construct a bladder substitute after radical cystectomy were described. The study reviewed retrospectively the results of 67 patients [61 males and 15 females with mean age of 61.5 years and mean follow up 30.7 months] who underwent different methods of continent urinary diversion [CUR]: Indiana pouch [n =55], Le Bag pouch [n =7], ileal cutaneous reservoir [n =2], gastro-ileal pouch [n =1] and orthotopic ileal neobladder [n =11]. Different continence and antireflux techniques were utilized. Early major complications related to CUR were 28.5% with 2.7% reoperation rate. Late major complications related to CUR included lower ureteric stenosis in 14.3% with 9.1% reoperation rate, pouch- ureteral reflux in 6.5% with no reoperation, stomal stenosis in 9.1% with 6.6% reoperation rate, continence rate: Total daytime and night time continence was 89% and 93%, respectively, in patients with cutaneous stoma diversion with 3.7% reoperation rate. Among patients with orthotopic ileal neobladder, daytime and nighttime continence rate was 100% and 66.6%, respectively, with no reoperation

Total bladder replacement by detubularised sigmoid colon segment.

A preliminary report of 3 cases of carcinoma bladder is presented in whom, after radical cystoprostatectomy, a low pressure neobladder is created from detubularised pelvic colon, with subsequent colo-urethral anastomosis. In selected cases, this is a feasible procedure with good patient acceptance as the normal body image is maintained. Also the low pressure neobladder ensures protection to the upper urinary tract from backpressure damage.

Continent ileocecal reservoir as a method of urinary diversion

Thirty evaluable patients who made at least 6 months of follow-up [max. 4y] are included. All cases were post-cystoprostatectomy for bladder cancer. The reservoirs were constructed by 3 principles. Detubularized and closed by Heineke-Mickulics reconfiguration [20 cases], detubularized terminal ileum incorporated [7 cases] and 2 longitudinal myotomy incisions alongside the anterior tenia with removal of strips of this tenia [3 cases]. Ureterocecal anastomosis was done with submucous tunnel [Goodwin type] in 48 units and direct mucosa to mucosa in 12 units. Continence was provided by ileal intussuscepted nipple fixed differently by non-stapled techniques [20 cases]. Ileocecal valve and antiperistaltic ileal segment [7 cases] and appendix in 2 cases. Patients were evaluated 3 monthly clinically and radiologically

Reservorio urinario continente / The continent urinary reservoir

Continent urinary reservoirs (CUR) have replaced ileum and colonic conducts as the best method for urinary diversion. The author present their experience with two patients in whom they fashioned a CUR in the Dr. Arnulfo Arias M. Metropolitan Complex using the ileocecal segment and part of the transverse colon (The Miami or Florida porch technique). They describe the clinical histories, surgical technique and the results obtained. They feel that the CUR has a large capacity, works at low pressure and is technically accessible. They consider it a good choice when urinary diversion is needed

Derivación urinaria continente con apéndice cecal: aplicación del principio de Mitrofanoff en 3 casos / Continent urinary diversion with appendix: Mitrofanoff principle application in 3 cases

En 1980 Mitrofanoff comunicó un tipo de derivación urinaria continente empleando el apéndice cecal desfuncionalizado e implantado en la vejiga con técnica antirreflujo. Esta técnica es empleada en esta serie en 3 pacientes, con excelentes resultados en términos de funcionalidad y continencia. El principio de Mitrofanoff representa una variación técnica factible de aplicar para lograr una derivación urinaria continente