A Clinical Study on Urinary Diversion and Reconstruction of the Urinary Tract with the Intestine

Kim, Sung Jin; Wang, Chong Soon

Abstract

In the field of urological surgery, the use of bowel has been established as methods of urinary diversion or reconstruction of urinary tract since ileal conduit was settled by Bricker in 1950. Urinary diversion or reconstruction with use of bowel segment is usually performed for the purposes of life saving and social adaptation of patients by removal of tumor itself and by preservation of renal function and normal urination. A favorable prognosis can be expected by urinary diversion utilizing a intestinal segment after removal of bladder and its surrounding tissues for the therapy of bladder carcinoma. In Korea, where tuberculosis is prevailing, interests of many urologists are centered on the preservation of bladder capacity for the treatment of contracted bladder complicating tuberculosis of urinary tract. But until recently, only a few experimental or clinical studies on urinary diversion and reconstructs on with use of the intestinal segment were reported in this country. A clinical observation was made on I7 cases of urinary diversion or reconstruction with use of the intestinal segment, which were performed on the patients admitted to the Department of Urology, Severance Hospital in 1977. The results are as follows: 1. The age distribution of patients was from 4th, to 6th. decades. 2. Among the patients, 13 cases were male and 4 cases were female bladder tumor were male. 3. The patients were consisted of 11 cases of bladder tumor, 5 cases of tuberculous contracted bladder and 1 case of a large vesicovaginal fistula 4. In operations, ileal conduit for 11 cases of bladder tumor, ileocystoplasty for 5 cases of tuberculous contracted bladder and ureterosigmoidostomy for 1 case of a large vesicovaginal fistula were performed. Acccmpanyingileal conduit, total cystectomy was performed in 10 cases end ligation of biateral hypogastric arteries only in the rest.5. In bladder tumor, comparing with pathological staging, the number of clinical understating and overstaging were 5 and 2 cases respectively. The pathological stages were not significantly correlated with the grades. 6. After ileocystoplasty for tuberculous contracted bladder, the intervals of urination was prolonged to 2 hours or more and improvement of incontinence was noted in all cases. 7. The blood levels of urea nitrogen and creatinine returned to normal except 1 case complicated with infection of urinary tract after operation. 8. The mean volumes of transfused blood during operation were 1,026ml for ileal conduit with total cystectomy, and 664ml for ileocystoplasty. The mean operation time was 5 hours and 56 minutes for ileal conduit with total cystectomy and 5 hours and 12 minutes for ileocystoplasty 10. The average postoperative duration were 18 days in ileal conduit with total cystectomy and 17 days in ileocystoplasty. 11. The postoperative complications included 5 cases of wound infection, 5 cases of urinary tract infection, 3 cases of paralytic ileus or mechanical ileus and 2 cases of urine leak.