[Ureterosigmoidostomy after total cystectomy in cancer. Long-term results. Apropos of 60 cases].
OBJECTIVE
Restoration of continuity of the urinary tract after total cystectomy deserves discussion even if most authors currently opt for bladder replacement or transileal cutaneous diversion. Diversion into the colon, which was used for a long time, has possibly been unjustly abandoned.


METHODS
From 1974 to 1995, sixty patients (116 renal units) underwent cystectomy for cancer, followed by systematic ureterosigmoidostomy when age and local conditions allowed. The mean age of the patients (52 men and 8 women) was 60 years. They were reviewed at least every six months and surveillance consisted of annual clinical and laboratory examinations and intravenous urography for 5 years. Evaluation of the functional results and quality of life was based on the information recorded in the patients' files and on the answers to a questionnaire for the 19 patients alive without recurrence.


RESULTS
The median follow-up was 80 months. Thirty seven patients have died, 23 (38.38%) of them from bladder cancer. Forty patients (66.6% had an uneventful immediate postoperative course. The major late complications were septic reflux in the upper urinary tract stenosis of the ureteric reimplantation and febrile urinary tract infections, requiring either repeat reimplantation or another diversion. Nocturnal (82%) and diurnal (85%) continence was good and 17 of the 19 patients alive with no signs of recurrence are satisfied with their lifestyle.


CONCLUSIONS
After total cystectomy for cancer, implantation of the two ureters into the colon remains a good method of urinary diversion due to its simplicity and good tolerance sometimes at the cost of a second operation. Recent technical modifications should restore the value of this operation.
Fournier
F
F
Service d'Urologie, CHU de Poitiers, France.
Bon
D
D
Doré
B
B
Aubert
J
J
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D012809:Colon, Sigmoid / Q000601:surgery*; D015653:Cystectomy; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011788:Quality of Life; D013997:Time Factors; D014513:Ureter / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*
L'urétéro-sigmoïdostomie après cystectomie totale pour cancer. Résultats à long terme. A propos de 60 cas.