[Continent urinary diversion using a tubulized sigmoid segment. An alternative to trans-appendicular diversion].

OBJECTIVE

The authors propose the use of a sigmoid tube reimplanted submucosally in the bladder and brought out onto the skin in the midline or in the umbilicus as a method of continent urinary diversion allowing urinary catheterization several times a day when the appendix cannot be used.

MATERIALS AND METHODS

Three adolescents with neurogenic bladder were treated according to this procedure; the summit of the sigmoid colon loop was selected to form a continent tube from a segment 4 cm wide, opened along its antimesenteric border and sutured longitudinally.

RESULTS

The postoperative course was uneventful in all 3 cases. The cystostomy was continent. Catheterizations were easily performed.

CONCLUSION

Creation of a sigmoid tube is an alternative to the use of the appendix for continent urinary diversion according to Mitrofanoff's procedure. This technique can always be performed due to the proximity of the sigmoid colon and bladder, which is not always the case with the appendix. This tube is richly vascularized and presents the advantage of a very narrow mesocolon which does not interfere with creation of the intravesical submucosal tunnel.