title: Combined urinary and fecal diversion using a no bowel anastomosis technique.
abstract: OBJECTIVE
  We present the experience at our institution with combined fecal and urinary diversion using 3 variations of a no anastomosis technique that avoids bowel anastomosis.
  
  
  METHODS
  The charts of 10 female and 2 male patients who underwent the no bowel anastomosis technique were identified and reviewed. Information on the etiology of urination and defecation abnormalities, surgical resolution, complications, hospital stay and other pertinent aspects of management were retrospectively reviewed.
  
  
  RESULTS
  Mean patient age was 64 years (range 36 to 83). Of the 12 patients 7 had a history of cancer treated with external beam radiotherapy, while 4 had neurological disorders with combined fecal and urinary incontinence or a history of colostomy. Mean hospital stay was 14.6 days (range 6 to 31) and mean followup was 26.6 months (range 14 to 52). There were no postoperative deaths, although a nonQ wave myocardial infarction occurred in 1 patient.
  
  
  CONCLUSIONS
  The no anastomosis technique of combined diversion is recommended in patients with preexisting or planned diversion of the fecal stream. Avoidance of bowel anastomosis makes this technique especially advantageous in those with a history of radiotherapy.
authors.affiliation: Department of Urology, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Costa
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Kreder
authors.forename: James R
authors.initials: JR
authors.lastname: Howe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D016737:Proctocolectomy, Restorative / Q000379:methods*; D016476:Urinary Reservoirs, Continent