Laparoscopic assisted continent urinary diversion in the pig.

PURPOSE

The ideal urinary reservoir would be low pressure, nonrefluxing and simple to construct. Hohenfellner recently described creating an in situ ureterosigmoidostomy with a 5 to 6 cm. detubularized portion of sigmoid colon and rectum (sigmoid-rectum pouch). In an effort to further study the reconstructive applications of laparoscopy, we sought to laparoscopically create a sigmoid-rectum pouch in an animal model. In addition, we sought to compare a "dunked" (right ureter) with a hand-sewn end-to-side ureterocolonic anastomosis (left ureter).

MATERIALS AND METHODS

Nine male domestic pigs underwent laparoscopic creation of a continent urinary diversion. Pouch creation and the ureterocolonic anastomoses were done extracorporeally; ureteral stents were not used. Average operative time was 122 minutes. Eight pigs survived the 10 to 12 week study period.

RESULTS

Mean pouch capacity was 360 cc and pouch pressure remained < 20 cm.H2O. Stones were noted on the bowel staple line in 44% of the animals. Ureterocolonic obstruction occurred in 11% of the right ureters and 33% of the left ureters.

CONCLUSIONS

A laparoscopically created continent sigmoid-rectum diversion appears to be feasible. A "dunked" ureterocolonic anastomosis provides equivalent or better drainage than a traditional hand-sewn ureterocolonic anastomosis. Problems with stone formation on the titanium staple line need to be resolved.