Continent right colon reservoir using a cutaneous appendicostomy.
BACKGROUND
Although orthotopic reconstruction has become the preferred form of lower urinary tract reconstruction after cystectomy there remains a select group of patients who are not appropriate for an orthotopic neobladder substitute. A continent cutaneous reservoir provides an alternative means to store urine and protect the upper urinary tract without the need for a urostomy appliance. We report our surgical technique of a continent cutaneous right colon reservoir using a catheterizable submucosally embedded appendicostomy.


METHODS
The continent cutaneous right colon reservoir with bilateral ureteroileal coloappendicostomy incorporates the ascending and proximal transverse colon, which are detubularized and folded to form the reservoir component of the urinary diversion. The terminal ileum acts as the afferent limb, with the intact native ileocecal valve providing the antireflux mechanism. The continence catheterizable mechanism incorporates the submucosally tunneled appendix with preservation of the mesentery in a flap-valve technique.


CONCLUSIONS
The continent cutaneous right colon reservoir with bilateral ureteroileal coloappendicostomy is a reasonable alternative for cutaneous urinary diversion when an intact appendix is present, with good functional results and excellent continence.
Stein
John P
JP
Department of Urology, Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, California 90089, USA.
Daneshmand
Siamak
S
Dunn
Matthew
M
Garcia
Maurice
M
Lieskovsky
Gary
G
Skinner
Donald G
DG
D001065:Appendix / Q000601:surgery*; D002404:Catheterization; D002431:Cecostomy / Q000379:methods*; D003106:Colon / Q000601:surgery*; D015653:Cystectomy; D006801:Humans; D016476:Urinary Reservoirs, Continent