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Die Entwicklung der Harnableitung in nicht ausgeschaltete Darmsegmente

The history of ureterosigmoidostomy

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Zusammenfassung

Angeborene Anomalien wie die Blasenextrophie waren der Grund, erstmals 1821 den Versuch einer Harnumleitung ins Rektum zu wagen. Erst 1894 gelang mit der Maydl-Operation ein gewisser Fortschritt mit 31% postoperativer Mortalität. Die entscheidenden Impulse zur Ureterosigmoidostomie kamen von Robert Coffey ab 1911. Stenosen der ureterokolischen Anastomose, entzündliche Komplikationen gepaart mit schweren Azidosen, Nierenfunktionsverlust und hoher Mortalität erlaubten ab 1950 den weltweiten Siegeszug des Ileumconduits, obwohl zeitgleich zu Bricker die Technik der Ureterosigmoidostomie durch Leadbetter, Goodwin und später Hohenfellner perfektioniert wurde. Etwa 25 Jahre später, als die hohe Spätkomplikationsrate des Ileumconduits offensichtlich wurde, besann man sich der Vorzüge der Ureterosigmoidostomie, verbesserte diese durch Einbeziehung der Erkenntnisse aus der Pouch-Chirurgie und konnte ihr so bis heute einen festen Platz im Repertoire der harnableitenden Verfahren sichern.

Abstract

Congenital anomalies like bladder exstrophy were the indication in 1821 to implant the ureters into the sigmoid colon for the first time. In 1894 the Maydl technique was used more frequently with a postoperative mortality rate of 31%. The most important impact for ureterosigmoidostomy came from Robert Coffey in 1911. Obstruction at the ureterocolic anastomosis, inflammatory complications together with severe acidosis, renal insufficiency, and high mortality rates however gave way in 1950 to the worldwide success of Bricker’s ileal conduit although at the same time the technique of ureterosigmoidostomy was perfected by Leadbetter, Goodwin, and Hohenfellner. About 25 years later, when the high late complication rate of ileal conduits was obvious, the advantages of ureterosigmoidostomy were reconsidered and the technique was refined using valuable principles of pouch surgery. Today modified ureterosigmoidostomy has a strong place among the possibilities of urinary diversion.

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  1. Klinik und Poliklinik für Urologie, Rheinische Friedrich-Wilhelms-Universität, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland

    S.C. Müller & P.J. Bastian

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  1. S.C. Müller
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  2. P.J. Bastian
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Correspondence to S.C. Müller.

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Müller, S., Bastian, P. Die Entwicklung der Harnableitung in nicht ausgeschaltete Darmsegmente. Urologe 47, 9–17 (2008). https://doi.org/10.1007/s00120-007-1591-3

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