Mansi M K
Section of Urology and Kidney Transplantation, Department of Surgery, King Fahad National Guard Hospital, PO Box 22490, Riyadh 11426, Saudi Arabia.
World J Surg. 1999 Feb;23(2):207-13. doi: 10.1007/pl00013166.
The objectives of urinary diversion are expanding from merely preserving kidney functions to enabling the patient to have a good quality of life while maintaining an acceptable certain body image. During the new era of continent urinary diversion the psychological drawbacks of noncontinent skin stoma in young adolescents cannot be overlooked. Ureterosigmoidostomy has been the technique of choice for continent urinary diversion in bladder extrophy patients when bladder reconstruction is not feasible or has failed. Although it provides a good daytime continence it is associated with a high rate of nighttime incontinence and delayed complications of pyelonephritis and hyperchloremic acidosis. We managed five male bladder extrophy patients with noncontinent skin stoma (sigmoid colon conduit in three and ileal conduit in two) including two patients who had previously had complicated classic ureterosigmoidostomy. They underwent urinary undiversion to the valved and augmented rectum (three patients) and the valved S-shaped rectosigmoid pouch (two patients) with some modifications. The conduit was used in the construction, and the ureters were implanted behind an isolated intussusception ileal nipple valve. Tube cecostomy and total parenteral nutrition was used for 7 to 10 days instead of a temporary defunctioning transverse colostomy. With a mean follow-up of 19.8 months (range 9-36 months) all the patients are fully continent during the day and night, with an emptying intervals of 3 to 6 hours. Follow-up intravenous pyelography and renal scans revealed improvement or stabilization of the function and configuration of the upper tracts in all renal units. No prophylactic alkali therapy was given. No clinical evidence of acidosis or symptomatic urinary tract infection was observed. Modified ureterosigmoidostomy is a good alternative for continent urinary undiversion even in those who have previously had complicated classic ureterosigmoidostomy. Our modification of using tube cecostomy and parenteral nutrition instead of a temporary transverse colostomy warrants attention; it made the technique simpler and more attractive.
尿流改道的目标已从单纯保留肾功能扩展到在维持可接受的身体形象的同时使患者拥有良好的生活质量。在可控性尿流改道的新时代，青少年非可控性皮肤造口的心理缺陷不容忽视。当膀胱重建不可行或失败时，输尿管乙状结肠吻合术一直是膀胱外翻患者可控性尿流改道的首选技术。尽管它在白天能实现良好的控尿，但夜间尿失禁率较高，且伴有肾盂肾炎和高氯性酸中毒等延迟并发症。我们治疗了5例男性膀胱外翻患者，他们采用了非可控性皮肤造口（3例为乙状结肠导管，2例为回肠导管），其中2例患者曾接受过复杂的经典输尿管乙状结肠吻合术。他们接受了将尿液改道至带瓣膜并扩大的直肠（3例患者）和带瓣膜的S形直肠乙状结肠袋（2例患者），并做了一些改进。在构建过程中使用了导管，输尿管植入孤立的套叠回肠乳头瓣后方。使用盲肠造瘘管和全胃肠外营养7至10天，而不是临时的功能性横结肠造口术。平均随访19.8个月（范围9 - 36个月），所有患者白天和夜间均完全可控，排尿间隔为3至6小时。随访静脉肾盂造影和肾脏扫描显示，所有肾单位的上尿路功能和形态均有改善或稳定。未进行预防性碱治疗。未观察到酸中毒或有症状的尿路感染的临床证据。改良输尿管乙状结肠吻合术即使对于那些曾接受过复杂经典输尿管乙状结肠吻合术的患者也是可控性尿流改道的良好替代方法。我们使用盲肠造瘘管和胃肠外营养替代临时横结肠造口术的改良方法值得关注；它使该技术更简单且更具吸引力。
