CONTINENT URINARY RESERVOIR (CUR) FOR SUPRAVESICAL DIVERSION

Pouchmetric Properties of the Colonic CUR and Role of Detubularization

Abstract

Eight patients underwent pouchmetry at 12 months after creation of the colonic continent urinary reservoir (CUR) for supravesical diversion. Pouchmetry revealed a volume-dependent tonic and phasic increase in pouch pressure in 3 patients who had undergone pouch construction using the partially detubularized right colon (Heineke-Mikulicz type closure after splitting the transverse and ascending colon at the antimesenteric border), whereas the volume-dependent phasic increase in pouch pressure was much less remarkable in 5 patients whose pouch was constructed using the totally detubularized right colon (Heineke-Mikulicz type closure after splitting the whole colonic segment including the cecum). The maximum pouch pressure at the pouch volume of 400 to 500ml was significantly higher (p<0.05) in the partial detubularization group (46±6.0cmH₂O, mean±S. D.) than in the total detubularization group (12±1.6cmH₂O). In creation of the low-pressure pouch using the right colon, detubularization should extend to the whole portion of the isolated colonic segment.