T R A N S V E R S E C O L O N - G A S T R I C TUBE C O M P O S I T E RESERVOIR C H R I S T O P I t E R R STEIDLE, M.D. IqlCtlARD S. FOSTF, R, M.D.

RICItARD BIHRLE, M.D. LA~NllENCE W. KLEE, M.D. MARK (2. ADAMS, M.D.

From the Department of Urology, Indiana University Medical Center, Indianapolis, Indiana

A B S T R A C T - - W e describe our technique fl)r a n e w f o r m of continent urinary diversion. This reservoir includes a detubularized segment of transverse colon to provide low pressure urine storage, tunneled ureteral reimplants to prevent reflux, and a tubularized gastric .segment used as a continent catheterizable eJ.#;rent limb. This technique provides a n e w option Jor continent diversion in a variety of patients'.

Since Gilchrist et al.~ introduced the ileocecal bladder in 1950, a number of procedures for continent urinary diversion have been reported, particularly over the past several years. Most of these techniques also utilize the ileoeeeal segment but modify it in a variety of ways. "2Other operations such as the Koek pouch and Camey procedure use exclusively terminal ileum, a,4 These various techniques all attempt to provide reliable continence and low pressure urine storage without reflux. Achievement of these goals relies on a variety of principles and surgical techniques which are shared by a number of these procedures• Some patients requiring bladder substitution are not candidates for many of these previously reported procedures. We have developed a new technique for continent urinary diversion that does not require use of the terminal ileum or ileocecat segment. We have previously reported this t e c h n i q u e and its favorable results in canines. 5 We have since successfully performed this p r o c e d u r e in adult patients and now describe the technique in detail, Material and Methods Preoperative preparation All patients undergo a thorough assessment of their upper urinary tract and are counseled

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on the need for life-long intermittent catheterization. Patients then undergo routine preoperative evaluation which includes assessment of their nutritional, cardiopulmonary, and re-i nal status. All patients undergo a thorough mechanical and antibiotic bowel preparation. Operative procedure T h e a b d o m e n is o p e n e d t h r o u g h a fulll midline incision. The ureters are divided at th0i level of the bladder or at the anastomosis to the4 existing conduit. The omentum is dissected oft~ tile transverse colon. ~lhe plane of the trans-:t verse mesoeohm is developed down to the bas~ of the mesenterv. A 25 to 30-cm segment ofj transverse colon"is selected based on the vaseu:1 lar supply from the middle colic vessels• Prior to dividing the colon and its mesenteryi~i the entire left and right colon are mobilized b~ dividing the peritoneal reflection in each col1 onie gutter• This allows for a subsequent ten-~ sion-f'ree colocolostomy. The selected segmen{ of transverse colon is isolated after a mesenteriC window is created at either end of the segment i Bowel continuity is restored by a eolocolostomy,I performed inferior to the isolated segment using: either a stapling or two-layer suture technique! The isolated segment is placed in the right up{ per quadrant. Each end of the colon segment isi

UI:K)LOCY

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JANUARY 1991

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VOI,UME XXXVII, NUMBEIt.~

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Transverse colon-gastric tube composite reservoir.

We describe our technique for a new form of continent urinary diversion. This reservoir includes a detubularized segment of transverse colon to provid...
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