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Current Concepts of Urinary Diversion in Men

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Bladder Cancer

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

Prior to the introduction of the ileal conduit more than four decades ago, the options for urinary diversion after cystectomy were extremely limited. Cutaneous pyelostomies and ureterostomies were common forms of urinary diversion. Direct cutaneous anastomoses of the collecting system offered patients a short-term diversion, but the benefits were soon outweighed by significant complications. The relatively poor intrinsic ureteral blood supply frequently lead to distal ureteral slough, recession of the stoma, or stricture formation. Even with the introduction of v-flap techniques designed to widen the stoma, the incidence of stoma stenosis was considerable (1). When diversion of longer duration was required, ureterosigmoidostomy was the popular choice. This allowed for the anal sphincteric mechanism to achieve urinary and maintain fecal continence and was technically simple to perform. Interestingly, the first ureterosigmoidostomy was reported by John Simon in 1852 (2) for the treatment of bladder exstrophy, making ureterosigmoidostomy the first continent urinary diversion. Using a transfixion suture between the ureter and rectum, he noted urine coming from the rectum on the tenth postoperative day. The patient subsequently died within a year.

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References

  1. Chute R, Sallade RL. Bilateral side-to-side cutaneous urethrostomy in the midline for urinary diversion. J Urol 1961; 85: 280.

    CAS  PubMed  Google Scholar 

  2. Simon J. Ectopia uesicae (absence of the anterior walls of the bladder and pubic abdominal parietes): operation for directing the orifices of the ureters into the rectum; temporary success; subsequent death; autopsy. Lancet 1852; 2: 568.

    Article  Google Scholar 

  3. Mathesin W. New method for ureterointestinal anastomosis. Preliminary report. Surg Gynecol Obstet 1953; 96: 255.

    Google Scholar 

  4. Goodwin WE, Scardino PT. Ureterosignoidostomy. J Urol 1977; 118: 169–172.

    CAS  PubMed  Google Scholar 

  5. Schoemaker van Stockum WJ, Strater M. Intra-abdominal plastieken. Ned T dschr Geeneekd 1911; 55: 823.

    Google Scholar 

  6. Bricker E. Bladder substitution after pelvic evisceration. Surg Clin North Am 1950; 30: 1511.

    CAS  PubMed  Google Scholar 

  7. Gilchrist RH, Merricks JW, et al. Construction of a substitute bladder and urethra. Surg Gynecol Obstet 1950; 90: 752.

    CAS  PubMed  Google Scholar 

  8. Tasker JH. Ileo-cystoplasty: a new technique. An experimental study with report of a case. Br J Urol 1953; 25: 349.

    Article  CAS  PubMed  Google Scholar 

  9. Giertz G, Frankson C. Construction of a substitute bladder, with preservation of voiding, after subtotal and total cystectomy. Acta Chir Scand 1957; 111: 218.

    Google Scholar 

  10. Goodwin WE, et al. “Cup-patch” technique of ileocystoplasty for bladder enlargement or partial substitution. Surg Gynecol Obstet 1959; 108: 240.

    Google Scholar 

  11. Husmann DA, McLorie GA, Churchill BN. Nonrefluxing colonic conduits: a longterm life-table analysis. J Urol 1989; 142: 1201–1203.

    CAS  PubMed  Google Scholar 

  12. Richie JP, Skinner DG. Urinary diversion: the physiological rationale for nonrefluxing colonic conduits. Br J Urol 1975; 47: 269–275.

    Article  CAS  PubMed  Google Scholar 

  13. Sullivan JW, Grabstald H, Whitmore WF Jr. Complications of ureteroileal conduit with radical cystectomy: review of 336 cases. J Urol 1980; 124: 797–801.

    CAS  PubMed  Google Scholar 

  14. Daughtry JD, Susan LP, Stewart BH, Straffon RA. Beal conduit and cystectomy: a 10-year retrospective study of ileal conduits performed in conjunction with cystectomy and with a minimum 5-year follow-up. J Urol 1977; 118: 556–557.

    CAS  PubMed  Google Scholar 

  15. Johnson DE, Lamy SM. Complications of a single stage radical cystectomy and ileal conduit diversion: review of 241 cases. J Urol 1975; 117: 171–173.

    Google Scholar 

  16. Jaffe BM, Bricker EM, Butcher HR Jr. Surgical complications of ileal segment urinary diversion. Ann Surg 1968; 167: 367–376.

    Article  CAS  PubMed  Google Scholar 

  17. Johnson DE, Jackson L, Guinn GA. Ileal conduit diversion for carcinoma of the bladder. South Med J 1970; 63: 1115–1118.

    Article  CAS  PubMed  Google Scholar 

  18. Pernet F, Jonas U. Ileal conduit urinary diversion: early and late results of 132 cases in a 25-year period. World J Urol 1985; 3: 140.

    Article  Google Scholar 

  19. Suare J, Walter S, Kristensen JK, Flemming L. Ileal conduit urinary diversion-early and late complications. Eur Urol 1985; 11: 83.

    Google Scholar 

  20. Butcher HR, Sugg WL, McAfee CA, Bricker EM. Ileal conduit method of ureteral urinary diversion. Ann Surg 1962; 156: 68.

    Article  Google Scholar 

  21. Schmidt JD, Hawtrey CE, Flocks RH, Culp DA. Complications, results and problems of ileal conduit diversions. J Urol 1973; 109: 210–216.

    CAS  PubMed  Google Scholar 

  22. Schmidt JD, Buchsbaum HJ, Jacobo EC. Transverse colon conduit for supravesical urinary tract diversion. Urology 1976; 8: 542–546.

    Article  CAS  PubMed  Google Scholar 

  23. Loening SA, Navarre RJ, Narayana AS, Culp DA. Transverse colon conduit urinary diversion. J Urol 1982; 127: 37–39.

    CAS  PubMed  Google Scholar 

  24. Morales P, Golimbu M. Colonic urinary diversion: 10 years of experience. J Urol 1975; 113: 302–309.

    CAS  PubMed  Google Scholar 

  25. Althansen AF, Hagen-Cook K, Hendren WH. Nonrefluxing colon conduit: experience with 70 cases. J Urol 1978; 120: 35–39.

    Google Scholar 

  26. Markland C, Flocks RH. The ileac conduit stoma. J Urol 1966; 95: 355.

    Google Scholar 

  27. Kafetsioulis A, Swinney J. Urinary diversion by ileal conduit. A long-term follow-up. Br J Urol 1968. 40: 1.

    Article  CAS  PubMed  Google Scholar 

  28. Retik AB, Perlmutter AD, Gross RE. N Engl J Med 1967; 277: 217.

    Article  CAS  PubMed  Google Scholar 

  29. Orr JD, Shand J, Watters DA, et al. Ileal conduit urinary diversion in children. An assessment of the long-term results. Br J Urol 1981; 53: 424–427.

    Article  CAS  PubMed  Google Scholar 

  30. Turnbull RB, Hewitt CR. Loop-end myotomy ileostomy in the obese patient. Urol Clin North Am 1978; 5: 423–429.

    PubMed  Google Scholar 

  31. Marshall FF, Leadbetter WF, Dretler SP. Ileal conduit parastomal hernias. J Urol 1975; 114: 40–42.

    CAS  PubMed  Google Scholar 

  32. Bloom DA, Lieskovsky G, Rainwater G, Skinner DG. The Turnbull loop stoma. J Urol 1983; 129: 715–718.

    CAS  PubMed  Google Scholar 

  33. Noble MJ, Mebust WK. Creation of the urinary stoma. AUA Update Series, Lesson 13, Vol 5, 1986.

    Google Scholar 

  34. Remigailo RV, Lewis EL, Woodard JR, Walton KN. Heal conduit urinary diversion. Urology 1976; 7: 343.

    Article  CAS  PubMed  Google Scholar 

  35. Middleton AW Jr, Hendren WH. Ileal conduit in children at the Massachusetts General Hospital from 1955 to 1970. J Urol 1976; 115: 591–595.

    Google Scholar 

  36. Shapiro SR, Lebowitz R, Colodny AH. Fate of 90 children with ileal conduit urinary diversions a decade later: analysis of complications, pyelography, renal function and bacteriology. J Urol 1975; 114: 289–295.

    CAS  PubMed  Google Scholar 

  37. Richie JP. Intestinal loop urinary diversion in children. J Urol 1974; 111: 687689.

    Google Scholar 

  38. Castro JE, Ram MD. Electrolyte imbalance following ileal urinary diversion. Br J Urol 1970; 42: 29–32.

    Article  CAS  PubMed  Google Scholar 

  39. Kosko JW, Kursh ED, Resnick MI. Metabolic complications of urologic intestinal substitution. Urol Clin North Am 1986; 13: 193–200.

    CAS  PubMed  Google Scholar 

  40. Heidler H, Marberger M, Hohenfellner R. The metabolic situation in ureterosigmoidostomy. Eur Urol 1979; 5: 39–44.

    CAS  PubMed  Google Scholar 

  41. McDougal WS. Use of intestinal segments and urinary diversion. In: Campbell’s Urology (Walsh PC, Retik AB, Vaughan ED, et al., eds.) Vol 3, 7th ed. Philadelphia, PA, WB Saunders, 1997, pp. 3121–3161.

    Google Scholar 

  42. Rowland RG, Mitchell ME, Bihrle R. The cecoileal continent urinary reservoir. World J Urol 1985; 3: 185.

    Article  Google Scholar 

  43. Rowland RG, Mitchell ME, Bihrle R, et al. The Indiana continent urinary reservoir. J Urol 1987; 137: 1136–1139.

    CAS  PubMed  Google Scholar 

  44. Bejany DE, Politano VA. Stapled and nonstapled tapered distal ileum for construction of a continent colonic urinary reservoir. J Urol 1988; 140: 491–494.

    CAS  PubMed  Google Scholar 

  45. Rowland RG, Bihrle R, Scheidler D, et al. Update on the Indiana continent urinary reservoir. Prob Urol 1991; 5: 269.

    Google Scholar 

  46. Rowland RG, Kropp BP. Evolution of the Indiana continent urinary reservoir. J Urol 1994; 152: 2247–2251.

    CAS  PubMed  Google Scholar 

  47. Rowland RG. Complications of continent cutaneous reservoirs and neobladdersseries using contemporary techniques. AUA Update Series 14: lesson 25. 1995.

    Google Scholar 

  48. Kock NG. Intra-abdominal “reservoir” in patients with permanent ileostomy: preliminary observations on a procedure resulting in fecal “continence” in five ileostomy patients. Arch Surg 1969. 99: 223.

    Article  CAS  PubMed  Google Scholar 

  49. Chen KK, Chang LS, Chen MT. Urodynamic and clinical outcome of Kock pouch continent urinary diversion. J Urol 1989; 141: 94–97.

    CAS  PubMed  Google Scholar 

  50. Skinner DG, Lieskovsky G, Boyd S. Continent urinary diversion. J Urol 1989; 141: 1323–1327.

    CAS  PubMed  Google Scholar 

  51. Weijerman PC, Schurmans JR, Hop WC, Schroder FH, Bosh JL. Morbidity and quality of life in patients with orthotopic and heterotopic continent urinary diversion. Urology 1998; 51 (1): 51–56.

    Article  CAS  PubMed  Google Scholar 

  52. Stein JP, Stenzl A, Grossfeld GD, et al. The use of orthotopic neobladders in women undergoing cystectomy for pelvic malignancy. World J Urol 1996; 14: 9–14.

    Article  CAS  PubMed  Google Scholar 

  53. Stein JP, Stenzl A, Esrig D, et al. Lower urinary tract reconstruction in women following cystectomy using the Kock ileal reservoir with bilateral ureteroilealurethrostomy: initial clinical experience. J Urol 1994; 152: 1404–1408.

    CAS  PubMed  Google Scholar 

  54. Cordonnier JJ, Ssjut HJ. Urethral occurrence of bladder carcinoma following cystectomy. Trans Am Assoc Genitourin Surg 1961; 52: 13.

    Google Scholar 

  55. Freeman JA, Esrig D, Stein JP, et al. Management of the patient with bladder cancer: urethral recurrence. Urol Clin North Am 1994; 21 (4): 645–651.

    CAS  PubMed  Google Scholar 

  56. Schellhammer PF, Whitmore WF Jr. Transitional cell carcinoma of the urethra in men having cystectomy for bladder cancer. J Urol 1976; 115: 56–60.

    CAS  PubMed  Google Scholar 

  57. Freeman JA, Tarter TA, Esrig D, et al. Urethral recurrence in patients with orthotopic ileal neobladders. J Urol 1996; 156: 1615–1619.

    Article  CAS  PubMed  Google Scholar 

  58. Iselin CE, Robertson CN, Webster GD, et al. Does prostate transitional cell carcinoma preclude orthotopic bladder reconstruction after radical cystoprostatectomy for bladder cancer? J Urol 1997; 158: 2123–2126.

    Article  CAS  PubMed  Google Scholar 

  59. Stein JP, Ginsberg D, Groshen S, Fang AC, Bochner B, Skinner E, et al. Urethral tumor recurrence following cystectomy and urinary diversion: clinical and pathological characteristics in 694 patients. J Urol, part 2, 161:264A, abstract 1020, 1999.

    Google Scholar 

  60. Camcy M, LeDuc A. L’entro-cystoplastic apres cystoprostatectomie totale pour cancer de la uessie. Indications, technique operatoire, surveilance et resultants sur quatre-uingt-sept cas. Ann Urol 1979; 13: 114.

    Google Scholar 

  61. Hautmann RE, Depetriconi R, Gottfried H, Kleinschmidt K, Mattes R, Paiss T. The ileal neobladder: complications and functional results in 363 patients after 11 years of follow-up. J Urol 1999; 161: 422–428.

    Article  CAS  PubMed  Google Scholar 

  62. Lippert CM, Theodorescu D. The Hautmann neobladder with chimney: a versatile modifications. J Urol 1997; 158: 1510–1512.

    Article  CAS  PubMed  Google Scholar 

  63. Hollowell CMP, Christiano AP, Steinberg, GD. Technique of Hautmann ileal neobladder with chimney modification: interim results in 50 patients. J Urol 2000; 163: 47–51.

    Article  CAS  PubMed  Google Scholar 

  64. Studer UR, Danuser H, Merz VW, Springer JP, Zingg EJ. Experience in 100 patients with an ileal low pressure bladder substitute combined with an efferent tubular isoperistaltic segment. J Urol 1995; 154: 49–56.

    Article  CAS  PubMed  Google Scholar 

  65. Ghoneim MA, Kock NG, Kycke G, Shehab El-Din AB. An applicance-free, sphincter-controlled bladder substitute: the urethral Kock pouch. J Urol 1987; 138: 1150–1154.

    CAS  PubMed  Google Scholar 

  66. Elmajian DA, Stein JP, Esrig D, Freeman JA, Skinner EC, Boyd SD, et al. The Kock ileal neobladder: updated experience in 295 male patients. J Urol 1996; 156: 920–925.

    Article  CAS  PubMed  Google Scholar 

  67. Kock NG, Ghoneim MA, Lycke KG, Mahran MR. Replacement of the bladder by the urethral Kock pouch: Functional results, urodynamics and radiological features. J Urol 1989; 141: 1111–1116.

    CAS  PubMed  Google Scholar 

  68. Stein JP, Lieskovsky G, Ginsberg DA, Bochner BH, Skinner DS. The T-pouch: an orthotopic ileal neobladder incorporating a serosal lined ileal antireflux technique. J Urol 1998. 159: 1836–1842.

    Article  CAS  PubMed  Google Scholar 

  69. Thuroff JW, Alken P, Riedmiller H, Jacobi GH, Hohenfellner R. 100 cases of Mainz Pouch: continuing experience and evolution. J Urol 1988; 140: 283–288.

    CAS  PubMed  Google Scholar 

  70. Marshall FF. Creation of an ileocolic bladder after cystectomy. J Urol 1988; 139: 1264–1268.

    CAS  PubMed  Google Scholar 

  71. Fisch M, Wammack R, Hohenfellner R. Seven years experience with the Mainz pouch procedure. Archivos Espanoles de Urologia 1992; 45: 175.

    CAS  PubMed  Google Scholar 

  72. Marshall FF, Mostwin JL, Radebaugh LC, Walsh PC, Brendler CB. Ileocolic neobladder post-cystectomy: continence and potency. J Urol 1991; 145: 502–504.

    CAS  PubMed  Google Scholar 

  73. Reddy PK. Detubularized sigmoid reservoir for bladder replacement after cystoprostatectomy. Urology 1987; 29 (6): 625–628.

    Article  CAS  PubMed  Google Scholar 

  74. DaPozzo LF, Colombo R, Pompa P, Montorsi F, et al. Detubularized sigmoid colon for bladder replacement after radical cystectomy. J Urol 1994; 152: 1409–1412.

    CAS  Google Scholar 

  75. Gerharz EW, Weingartner K, Dopatka T, Kohl UN, Basler HD, Riedmiller HN. Quality of life after cystectomy and urinary diversion: results of a retrospective interdisciplinary study. J Urol 1997; 158: 778–785.

    Article  CAS  PubMed  Google Scholar 

  76. Boyd SD, Feinberg SM, Skinner DG, Lieskovsky G, Baron D, Richardson J. Quality of life survey of urinary diversion patients: comparison of ileal conduits versus continent Kock ileal reservoirs. J Urol 1987; 138: 1386–1389.

    CAS  PubMed  Google Scholar 

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Authors
  1. Courtney M. P. Hollowell MD
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  2. Gary D. Steinberg MD
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  3. Randall G. Rowland MD, PhD
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Editors and Affiliations

  1. Department of Urology, Mount Sinai School of Medicine, New York, NY, USA

    Michael J. Droller MD

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Hollowell, C.M.P., Steinberg, G.D., Rowland, R.G. (2001). Current Concepts of Urinary Diversion in Men. In: Droller, M.J. (eds) Bladder Cancer. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-097-1_13

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  • DOI: https://doi.org/10.1007/978-1-59259-097-1_13

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-202-5

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