title: Rectosigmoidal bladder utilizing intussuscepted ileal segment: a surgical technique for urinary diversion and experiences in 30 patients.
abstract: BACKGROUND
  We previously reported that the ileocecal rectal bladder consists of interposition of an intussuscepted ileocecal segment between the ureters and the rectum for those in whom the urethra is not available. Although the ileocecal rectal bladder has been well accepted by most patients, it requires an extensive preparation along the ascending colon. We present a modified operation technique (rectosigmoidal bladder) by using the ileal segment alone as an interposing antireflux component and by using the sigmoidal segment to augment the rectal capacity.
  
  
  METHODS
  From February 1993 to July 2002, 30 patients with a median age of 64 years underwent construction of a rectosigmoidal bladder. Median follow-up period was 26 months (range, 13-125). The follow up was carried out using clinical and functional assessments such as evacuation status, serum chemistry and radiographic evaluation of the upper urinary tracts and rectosigmoidal pouch. To assess the postoperative health-related quality of life, we carried out a survey comparison of the ileocecal rectal bladder patients and the rectosigmoidal bladder patients.
  
  
  RESULTS
  No operative or urinary diversion-related postoperative mortality was encountered. All rectosigmoidal bladders had sufficient capacity, with no evidence of urinary reflux or daytime incontinence. When compared with our previous procedure, the ileocecal rectal bladder, the present procedure had advantages with respect to complications with urine-fecal leak and acidosis. There were no differences in mean operation time, or in the health-related quality of life survey, between the two procedures.
  
  
  CONCLUSIONS
  Our experience showed that this technique should be considered for those in whom the urethra is not available.
authors.affiliation: Department of Urology, Akita University School of Medicine, Akita, Japan. coyama@doc.med.akita-u.ac.jp
authors.forename: Chikara
authors.initials: C
authors.lastname: Ohyama
authors.forename: Norihiko
authors.initials: N
authors.lastname: Tsuchiya
authors.forename: Tomonori
authors.initials: T
authors.lastname: Habuchi
authors.forename: Kazunari
authors.initials: K
authors.lastname: Sato
authors.forename: Shigeru
authors.initials: S
authors.lastname: Satoh
authors.forename: Naotake
authors.initials: N
authors.lastname: Shimoda
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D012809:Colon, Sigmoid / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery; D011788:Quality of Life; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*; D016476:Urinary Reservoirs, Continent; D014594:Uterine Neoplasms / Q000601:surgery