1988 Volume 79 Issue 8 Pages 1418-1426
We report on creation of the colonic continent urinary reservoir for supravesical diversion. The right colon (cecum, ascending colon and the right third of transverse colon) along with a 15-18cm segment of the terminal ileum is isolated. The colonic segment is split open at the anterior taenia. The ileal mesentery is stripped for 8cm proximal to the ileocecal valve and the denuded ileum was intussuscepted into the cecum. The intussuscepted ileal nipple is stabilized by using a Dacron mesh collar at the base of the intussusception and by making a 2-3cm longitudinal full-layer incision through the outer layer of the ileal nipple and the opposite colonic wall and sewing the ileal edges to the colonic edges. Following an antirefluxing ureterocolonic anastomosis using the submucosal tunnel method, the colonic segment is closed transversely (Heineke-Mikulicz type closure) to disrupt the tubular nature of the colon. A flush stoma is created in the right lower quadrant so that the ileal limb can reach the skin as short as possible. The Dacron mesh collar is fixed securely to the anterior rectus sheath opening. To date we performed this procedure in 7 patients. All patients remained dry day and night with easy intermittent self-catheterization during 3 to 17 months (average 11 months) of followup. Pouchmetry revealed low pressure reservoirs with capacities of more than 500ml. All patients had stable upper tracts without reflux. No early postoperative complications were encountered. No electrolyte disturbance or malabsorption syndrome was observed.
