Shortand long-term results of ureterosigmostomy with creation of Mintzpouch II and Hasan reservoir

详细

The aim of the study was analysis of short- and long-term results
of treating patients operated with intestinal replacement of the urinary
bladder by Mintz pouch II and Hasan. Thirty-two ureterosigmostomies
with creation of the reservoir from the rectosigmoid angle (17
Mintz pouch II and 15 Abol-Enein operations) were made from
1997-2002. The age of the patients ranged from 16 to 73, the follow-up
was 12-72 months. The operation was indicated in infiltrative cancer
of the urinary bladder, microcystis of various etiology, extrophy
of the urinary bladder. Postoperative urine retention was observed in
all the patients both in the day and night time. Renal function remained
unchanged or improved in 93% patients. Quality of life was
good. All the patients except two with recurrent attacks of pyelonephritis
were socially adapted. Able patients resumed their jobs. Early
after the operation one woman developed incompetence of the sutures
of the reservoir anterior wall which required relaparotomy. Four patients
died of local recurrence and/or distant metastases in different
terms after surgery. Two patients had reflux with frequent attacks of
pyelonephritis as well as a serious impairment of acid-base balance
manifesting as hyperchloremic acidosis, the other two patients had
late unilateral strictures of the intestinoureteral anastomosis which
was reestablished. Thus, updated ureterosigmostomy significantly reduces
the rate of complications and is a good alternative to heterotopic
and ortotopic urine derivation in contraindications for the operations.
Moreover, Hasan's operation allows implantation of delated
ureters. In most cases, ureterosigmostomy with formation of reservoir
from rectosigmoid angle provides good quality of life in adequate selection
of patients.