Virseda Rodríguez J A
Servicio de Urología, Hospital General de Albacete, España.
Arch Esp Urol. 1992 Nov;45(9):927-36.
From 1988 to 1992, six patients underwent surgery to create a functional rectosigmoid neobladder following the technique initially described by Kock and Ghoneim. Four also had a total cystectomy (3 females were submitted to cystourecterectomy). This new continent urinary diversion procedure was performed at the time of reoperation in two previously cystectomized patients with complicated ileal conduits due to ureteroileal stenosis. There were no postoperative deaths. Two cases presented minor complications postoperatively (prolonged paralytic ileus and wall abscess). The follow up period ranged from 3 months to 4 years. All patients were continent during the day and voided every 4 to 6 hours. They were continent during the night and voided once or twice. Preservation of renal function was demonstrable analytically and urographically. The proctogram and proctography disclosed a rectosigmoid neobladder with a big capacity, low pressures and good adaptability to filling. Ureteral reflux was not observed and colosigmoid reflux was minimum, although they did not have the second valve (colosigmoid) of the original technique. Because the procedure is acceptable for the patients and achieves good results, this new alternative continent urinary diversion procedure should be considered for those patients who refuse cutaneous urinary diversion and for those in whom construction of an ileoureteral reservoir is not possible.
1988年至1992年期间，6例患者按照Kock和Ghoneim最初描述的技术接受了手术，以创建功能性直肠乙状结肠新膀胱。其中4例还进行了全膀胱切除术（3名女性接受了膀胱切除直肠切除术）。这一新型可控性尿流改道术是在2例先前因输尿管回肠吻合口狭窄而接受膀胱切除术的患者再次手术时实施的。术后无死亡病例。2例术后出现轻微并发症（麻痹性肠梗阻延长和腹壁脓肿）。随访时间为3个月至4年。所有患者白天均能自主控制排尿，每4至6小时排尿一次。夜间也能自主控制排尿，排尿一至两次。肾功能通过分析和尿路造影证实得以保留。直肠造影和直肠X线摄影显示直肠乙状结肠新膀胱容量大、压力低且对充盈的适应性良好。未观察到输尿管反流，结肠乙状结肠反流极少，尽管他们没有原始技术中的第二个瓣膜（结肠乙状结肠瓣）。由于该手术对患者来说是可以接受的，并且取得了良好的效果，对于那些拒绝行皮肤造口尿流改道的患者以及那些无法构建回肠输尿管储尿囊的患者，应考虑采用这种新型替代的可控性尿流改道术。
