EVALUATION OF CONTINENT CUTANEOUS URINARY DIVERSIONS

Abstract

Continent urinary diversion is frequently indicated. Although orthotopic bladder substitution is the most appealing technique to the patients, there are several limitations which make the procedure unfeasible. Urinary reservoirs with continent outlet to the skin is the second alternative when orthotopic substitution could not be performed.

There are many techniques described over the last two decades, most of them depends on unphysilogic principle, .. therefore problems soon appear mostly due to failure of the continence mechanism.

Between January 1999 and August 2001, 16 patients (13 males-3 females) underwent; continent cutaneous urinary diversion ; following cystectomy for bladder cancer in 12, other benign conditions in 4, including useless bladder , lost urethra and conversion from other type of diversion . Patient age ranged from 7-65 years.

The technique entails creation of a urinary reservoir constructed frmn 60cm long segment from the terminal ileum. The pouch is mounted by two unidirectional valves using the serous lined extramural technique. One is used for antirefluxive ureteral reimplantation constructed from tapered ileal segment and the other serves as a continent outlet and constructed from tapered ileum in 14 patients and from appendix in the remaining two.

Early cotnplications were observed in 4 patients ; wound infection and paralytic ileus, urinary leakage, uretero-ileal obstruction and each in one. All these complications were treated conservatively including . Follow up period ranged between 6-18 months with mean of 12.