A Case of Ureteroileocecal Sigmoidostomy with Sigmoid J Pouch

Chung, Moon Kee; Seo, Ho Kyung

Abstract

We performed a case of ureteroileocecal sigmoidostomy in a 56-year-old female patient who had transitional cell carcinoma of the bladder(pT3aNoMo, grade III, mutiple, papillary). Both ureters were anastomosed to the ileal end of the ileocecal segment and colonic end was anastomosed to the J pouch of the sigmoid colon. At 7 months postoperatively, the intraluminal pressure of the pouch is 20 cmH2O in supine position, 40 cmH2O in sitting or squatting position, 90-100 cmH2O on voiding. No visible reflux of fecal and urinary stream into upper urinary tract was observed on both antegrade and retrograde pouchgraphy. No ectatic changes of upper urinary tract was seen on excretory urography until 36 months postoperatively. There was no changes in CBC, liver function, renal function and serum electrolytes. Even though there had been no febrile attack without any antibiotic medications during follow-up period, bilateral renal scarring was observed on CT films of postoperative 24 months. Continuous suppressive dose of sulfamethoxazole- trimethoprim was started. She passes urine in diarrhea pattern every three to four hours and has no leakage in night time. She satisfies with status of voiding at present after 30 months postoperatively. No visible reflux into upper urinary tract from the pouch is identified, ascending infection could not be prevented by this antireflux method only. This procedure can be an alternative way of urinary diversion in the era of bladder substitution if ascending infection can be prevented by enforced and more secure procedures to prevent reflux are added.