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Titolo:
Transverse retubularized sigmoidovesicostomy continent urinary diversion to the umbilicus
Autore:
Van Savage, JG; Yepuri, JN;
Indirizzi:
Univ Louisville, Sch Med, Dept Surg, Dept Pediat Urol, Louisville, KY 40292 USA Univ Louisville Louisville KY USA 40292 at Urol, Louisville, KY 40292 USA
Titolo Testata:
JOURNAL OF UROLOGY
fascicolo: 2, volume: 166, anno: 2001,
pagine: 644 - 647
SICI:
0022-5347(200108)166:2<644:TRSCUD>2.0.ZU;2-9
Fonte:
ISI
Lingua:
ENG
Soggetto:
EARLY CLINICAL-EXPERIENCE; MONTI PROCEDURE; APPENDICOVESICOSTOMY; CHILDREN; STOMA; CATHETERIZATION; CONSTRUCTION; BOWEL;
Keywords:
urinary diversion; umbilicus; bladder; neurogenic; spinal dysraphism;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
19
Recensione:
Indirizzi per estratti:
Indirizzo: Van Savage, JG Univ Louisville, Sch Med, Dept Surg, Dept Pediat Urol, Louisville, KY 40292 USA Univ Louisville Louisville KY USA 40292 ille, KY 40292 USA
Citazione:
J.G. Van Savage e J.N. Yepuri, "Transverse retubularized sigmoidovesicostomy continent urinary diversion to the umbilicus", J UROL, 166(2), 2001, pp. 644-647

Abstract

Purpose: The most widely used conduit when creating continent urinary diversion based on the Mitrofanoff principle has been appendicovesicostomy. However, appendix is not always available and it is increasingly used for the antegrade continence enema in situ appendix procedure. In 1993 the technique of transverse retubularization of the ileum to create a continent catheterizable conduit for an ileal reservoir was described and in 1997 this technique was studied in an animal model. Larger patients may need 2 ileal segments in series to bridge the distance between the umbilicus and bladder. To avoid using 2 segments we used transverse retubularized sigmoid colon to create a catheterizable sigmoidovesicostomy to the umbilicus. Materials and Methods: In 5 children 6 to 19 years old (mean age 15) with neurogenic bladder secondary to spina bifida a transverse retubularized sigmoidovesicostomy to the umbilicus was performed. In all patients an antegrade continence enema procedure was done for refractory constipation and overflow fecal incontinence secondary to neurogenic bowel. Laparoscopy was performed to mobilize the appendix in patients who requested a low Pfannenstielincision for better cosmesis. Additional procedures included the pubovaginal sling placement and sigmoid colocystoplasty. Results: Mean length of the sigmoidovesicostomy, which was equal to the circumference of the sigmoid before retubularization, was 13 cm. (range 10 to15). This sigmoid conduit reached the umbilicus easily in all cases. All sigmoidovesicostomies were easily catheterized and all were continent. One patient with morbid obesity (body mass index 40.4) had a mucocutaneous anastomotic breakdown 3 months postoperatively. Minimum followup was 1 year (mean 1.5). Conclusions: Transverse retubularized sigmoidovesicostomy is effective forcreating a continent urinary diversion to the umbilicus in patients with neurogenic bladder secondary to spina bifida. Dilating the sigmoid colon from neurogenic bowel creates a long conduit based on the Yang-Monti principleand 2 ileal segments with an anastomosis are not required. Additional benefits are that the sigmoid colon is readily accessible via a low PfannenstieI incision and may also be used for augmentation in select cases.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 13/07/20 alle ore 08:00:24