ABSTRACT
A total of six male patients, who had undergone radical cystectomy and sigma-rectum pouch surgery due to bladder cancer (2-5 years previously), developed hyperchloremic metabolic acidosis, hypokalemia and renal dysfunction. The patients underwent urinary undiversion surgery (the pouch was isolated from the intestinal tract, abdominal ostomy was performed, and the sigmoid colon and rectum were reconnected) and blood gas and electrolyte analysis and renal function were compared pre- and post-surgery. Blood hydrocarbonate levels significantly improved 3 months post-surgery compared with the preoperative levels (17.90±4.12 vs. 7.57±4.25; P=0.026). At 6 months post-surgery, blood pH (7.36±0.04 vs. 7.16±0.08; P=0.028) and potassium levels (3.95±0.38 vs. 3.12±0.21; P=0.032) were found to have improved significantly compared with the pre-surgery levels, and remained normal. Serum creatinine levels decreased significantly from the preoperative levels at 6 months post-surgery (213.00±44.85 vs. 304.67±55.58; P=0.028). Serum chlorine (99.17±2.75 vs. 110.90±4.38; P=0.038) significantly improved until 3 years post-surgery. The results of this case report indicated that urinary undiversion from a sigma-rectum pouch to a cutaneous urinary stoma that separates the pouch and intestine may be a beneficial treatment for post-sigma-rectum pouch surgery acidosis and electrolyte disturbances.
ABSTRACT
Objective To investigate the application value of urine excrement shunt surgery for the treatment of severe metabolic disorders after Sigma rectum pouch of bladder cancer.Methods From July 2011 to December 2013,4 male patients (mean age 72±10 years old,ranged from 58-82 years old),who received radical cystectomy and Sigma rectum pouch due to bladder cancer,were admitted in our hospital.Within four years after the operation,all patients complained about the recurrent fatigue,anorexia and even unconsciousness.The hyperchloremic metabolic acidosis,hypokalemia and renal dysfunction were diagnosed by blood gas analysis and biochemical tests.One week before urine excrement shunt operation,the arterial blood pH,HCO3-,serum potassium,chloride and creatinine were (7.15±0.08),(7.8±4.7)mmol/L,(3.1 ±0.2) mmol/L,(110.3±4.7) mmol/L,(314.8±66.4) μmol/L,respectively.They received urine excrement shunt surgery.The lower abdominal mid-line incision was made and the pouch was isolated from intestinal tract.The abdomen ostomy was made and the sigmoid colon and rectum were re-coincided in order to recover the intestinal continuity.The results of blood gas analysis,electrolytes and renal function after surgery were compared with those before surgery.Results The average operation time was (256.3±26.9) min and the mean volume of bleeding was (147.5±111.2) ml.There was no surgery related complication.Blood bicarbonate was (19.1±4.8) mmol/L one week after surgery,which was significantly improved than that before operation (P＜0.05).One month later,blood pH level descended to (7.38±0.05),potassium level was (3.9±0.3) mmol/L,creatinine was (208.8±50.8) umol/L.All of them were significantly improved,compared with those results before surgery (P＜0.05).Blood chloride was significantly reduced to (102.4±5.8) mmol/L (P＜0.05) after 6 months of operation.Nobody developed severe acidosis and electrolyte disturbances during 6 months to 3 years' follow-up.Conclusions Urine excrement shunt surgery can effectively corrected the acidosis and electrolyte disturbances due to the radical cystectomy and Sigma rectum pouch.It might be a alternative method to treat such kind of severe complications.
ABSTRACT
Objective To assess the continent diversion results of sigma rectum pouch after radical cystectomy. Methods The reconstruction of bladder with sigmoid was modified for treatment of 18 cases of bladder tumor.The intestine was incised over a length of 20～24 cm with the junction of sigmoid colon and rectum as the midpoint so as to create a low pressure reservoir for urine and side-to-side anastomosis was performed on the posterior borders of the rectosigmoid wall.Submucosal tunnel modified technique was em- ployed in antireflux urethral implantation,Urination has been controlled by anal sphincter.Results About 80 minutes was spent to finish a new low pressure pouch after radical cystectomy.Among 18 patients with this op- eration,the controlled emiction were good after pull out the anal duct and"J"stent in 1 week to 2 months.Af- ter 2 months,the times of urination is stable,4～5 times in daytime and 1～3 times during nighttime.Two pa- tients had nocturnal enuresis and the symptom vanished after 2 months. One patient had adhesive ileus, two patients had hyperchloremia acidosis and kaliopenia,one patient had urethral stump cancer.There is no com- plication as anastomotic block,renal function lesion and severe upper urinary tract infection. Conclusion This operative method was easy,emiction control was well,and with higher quality of life for patients.It is al- so a better alternative diversion procedure that would be easily accepted.