Abstract

Objectives: Nowadays, instead of ileal and colonic conduits, continent urinary diversions are preferred. Although many techniques for achieving continence were described, a reliable and easily performed procedure with a low rate of complications is not yet defined.

In this study, we evaluated the results in patients, in whom catheterizable stoma was performed by using transvers retubularized intestinal segment.

Materials and methods: We performed catheterizable stoma by using transvers retubularized intestinal segment (TRIS) in 12 patients (3 women, 9 men) between January 1997 and February 2002. The mean age of patients was 37.7 years (range 14 to 66). Out of patients in the study group, 5 had urinary retention, 2 had severe incontinence with weak urinary stream, 4 were totally incontinent and 1 patient had urinary retention with severe urgency. The mean time for the presence of these complaints was 3.5 years ranging between 1-27 years. As the etiologies were considered, 5 patients had spinal cord injury, 4 had urethral stenosis, 1 had multiple sclerosis, 1 had myelodisplasia and 1 patient had vesicovaginal fistula. Two patients with spinal cord injury and 1 patient with urethral stenosis used permanent urethral catheters. TRIS was performed as an additional procedure during cystectomy and Mainz 1 operation in 2 patients, augmentation ileocystoplasty in 5 patients, bladder neck closure in 2 patients and augmentation ileocystoplasty with bladder neck closure in 2 patients. Additionally, in one patient with urethral stenosis, TRIS was applied alone, directly to the bladder. TRIS was implanted in the intestinal segment in the patient, cystectomy and Mainz 1 was performed, and in other patients it was implanted in native bladder. TRIS was performed in 10 patients by the use of ileum, and in 2 patients by the use of sigmoid colon due to the shortness of the pedicle.

Results: The median hospitalization time was 21 (7-60) days and complications developed in 3 patients (25%) in the postoperative period. One patient had wound infection and paralytic ileus due to electrolyt imbalance, one patient had difficulty in catheterization and in another patient urinary fistula developed in the postoperative 3rd day. In the patient who developed urinary fistula, it was found out that the drain was inside the augmented bladder. The drain was moved backwards, cystostomy and urethral catheters was held longer and removed under the control of cystography. In the patient, with the complain of difficult catheterization, stomal stenosis was enlarged two times by the performance of ballon dilatation in the postoperative 3rd and 21st months. In the long follow-up period, all the patients have been using clean intermittant catheterization (CIS) and were continent between the intervals. The median follow-up period was 40 months (18-79). The evaluation of upper urinary tract and biochemical analyzes were normal in all patients.

Conclusion: In continent urinary diversions, TRIS should be considered as the first choice method since it is easy to perform as an additional procedure to the other lower urinary tract reconstructive procedures. Besides it is easily available, efficient to provide continence, easy to catheterize and has low rate of complications during the follow-up.