Fisch M, Wammack R, Müller S C, Hohenfellner R
Department of Urology, University of Mainz School of Medicine, Germany.
J Urol. 1993 Feb;149(2):258-63. doi: 10.1016/s0022-5347(17)36050-0.
A low pressure rectosigmoid reservoir for urine is created obviating the need for colostomy, augmentation or extensive bowel surgery. Antimesenteric splitting of the intestine at the rectosigmoid junction and subsequent side-to-side anastomosis are performed. Urodynamic data demonstrate that the detubularization is effective in rendering high pressure bowel contractions ineffective. Without the risk of damaging the mesentery the pouch is fixed at the promontory, which lessens the risk of ureteral kinking and upper urinary tract dilatation. The technique is indicated not only in cases of failed ureterosigmoidostomy but also for primary urinary diversion. All 47 patients who underwent the operation were evaluable with a followup of 1 to 20 months (mean 10 months). All patients are continent during the daytime with a mean emptying frequency of 5 times. All but 1 elderly woman are dry at night with a mean frequency of 1 episode. With the reservoir full the basal pressure was 24 cm. water and the highest peak pressure recorded was 35 cm. water. The low pressure improves continence, protects the upper urinary tract and even allows dilated ureters to be implanted.
创建一个用于尿液的低压直肠乙状结肠储尿囊，从而避免了结肠造口术、扩大手术或广泛的肠道手术的需要。在直肠乙状结肠交界处进行肠管的系膜对侧劈开，随后进行侧侧吻合。尿动力学数据表明，去管化有效地使高压肠段收缩无效。在不损伤系膜的情况下，将储尿囊固定于岬部，这降低了输尿管扭结和上尿路扩张的风险。该技术不仅适用于输尿管乙状结肠吻合术失败的病例，也适用于原发性尿流改道。接受该手术的47例患者均适合评估，随访时间为1至20个月（平均10个月）。所有患者白天均能自主控制排尿，平均排空频率为5次。除1名老年女性外，所有患者夜间均无遗尿，平均发生率为1次。储尿囊充盈时，基础压力为24厘米水柱记录到的最高峰值压力为35厘米水柱。低压改善了控尿能力，保护了上尿路，甚至允许将扩张的输尿管植入。
