Surgical treatment of Contracted Bladder: Clinical observation of 30 cases of sigmoidocystoplasty

Kim, Yong Woo; Hertzberg, Johan; Kim, K S

Abstract

Reconstruction of contracted bladder with a segment of small or large bowel has got a wide acceptance in the urological field today The use of a sigmoid colon segment isolated from the fecal stream appears to be most feasible for replacing or enlarging the bladder because the sigmoid colon with its proximity to the bladder would be the most logical donor organ. It might even be assumed so from a functional point of view. From January. 1961 to December 1962. in the Department of General Surgery. National Medical Center there has been performed 30 sigmoidocystoplasties for contracted bladder. The purpose of this paper is to present comparative clinical features of the reconstructed bladder and post-operative complications following closed loop and cup form sigmoidocystoplasty. Material: Of 30 cases of contracted bladder, 28 were contracted T. B bladder and 2 were non-specific cystitis. All 30 cases had previously undergone nephrectomy due either to non-functioning kidney, or extensive destruction. Seventeen cases were males and 13 cases were females. Agewas ranging from 12 to 67 years Two different techniques of sigmoidocystoplasty have been employed, namely closed loop (13 cases) and cup-form (17) sigmoiducyetoplasty, therefore, it has been possible to make a comparative study between two techniques. Clinical result and Conclusion: 1) Bladder reconstruction by means of an isolated sigmoid segment resulted in producing an efficaciously functioning artificial bladder as a urinary reservoir. No mortality 2) One case which was a complete failure was a case of contracted T. B. bladder with urinary incontinence, therefore, it should be emphasized that urinary incontinence is an absolute contraindication for sigmoidocystoplasty. 3)Bladder reconstructi with cup-form sigmoidocystoplasty was superior to closed loop sigmoidocystoplasty because of; A) Shape, position and Prevention of residual urine formation of the reconstructed bladder. B) Tidal volume as closed as total bladder volume. C) Very similar cystometry curve to the normal. D) Reduction of post-operative complication. 4) Production of mucus urine causes troublesome discomfort to the patient after bladder reconstruction, therefore, it would be ideal if we can prevent mucous urine. 5) Although the serum chloride has some tendency to increase after sigmoidocyetoplagty, however, no hyperchloremic acidosis was produced if the kidney function was normal. 6) All hyperchloremic acidosis cases in this series had irreversible hydronephrosis of the remaining kidney. This might give the impression that severe hydronephrosis is a contra-indication to sigmoidocystoplasty. However, as a contracted bladder gives not only miserable urinary symptoms but also shortens the life by progressive destruction of be kidney, the indication for reconstruction of a contracted bladder, even in the presence of severe hydronephrosis, should be discussed. A non-absorbable reconstructed bladder should be most ideal artificial bladder.