Urine Supravesical Derivation by Using the Intestine

Abstract

Abstract    

Background: Urine derivation after cystectomy or bladder functional impairment more than century is a very actual problem.   During this time  many oparating tecniques are provided after cystectomy due to bladder cancer and non-cancerous diseases.  Some of which have been completely abandoned, others are still being adopted. However, the widespread interventions are far from perfect and their results can not satisfy both surgeons and patients expactations.  Advanced urological thought has always tried to create such methods of urine derivation, which ensure human life activity, as close as possible to physiological, wich does not lead to psycho-emotional discomfort of the patient   and provide high "quality of life".

Aim:    The article describes development of  different tecniques  of supravesical derivation and cystoplastic issues after cystectomy in Georgia from 1929 until now

 Materials and Methods: 72 patients with different bladder damage. Pre-operative preparation that includes: diet one week before the operation, the medicine are prescribed for intestinal microflora, checked Cardiovascular, Respiratory system and urinary systems. Patients with specific diseases (for example TB) anti-TB therapy.

for augmentation we need 40-50 cm of ileum intestine. Which we get it from ileocecal angle 20-30 cm away. The integrity of the intestinal tract is restored by applying an anastomosis between the proximal and distal ends of the intestine. The isolated intestinal segment on the vascular pedicle is detubulated and reconfigured in the form of Latin U or W. The medial side of the detobuled intestinal loop is anastomosis with spatulate ureters with 6-8 nodal Vicryl 4.0 sutures. With Vicryl 3.0 continuous stitches, the opposite sides of the detubulated loop of the intestines are sutured and formed " apron ". Only then does the reservoir are formed.

    Anastomosis of the ureters is performed in the lower part of the intestinal area. Finally, after the formation of the " low-pressure small intestine reservoir’’, the implanted ureters are topographically aligned with the Lieto triangle, with appropriate physiology, and this is also the most fixed place in the reservoir.

Results:

After operations:

• Lethal accident was not detected

• All patients were continental

• Patients with neurogenic bladder patients were all on self-catheterization

• Four men had urinary retention due to prostate hyperplasia; prostate TUR was done

• Six patients formed stones in the reservoirs, optical cystolithotripsy was done

• No clinically significant reflux was observed in any patient.

Conclusions:

• We got an anti-reflux effect.
• After the surgery we had not anastomosis stenosis and reflux.
  •        The method is technically simple and can be widely used in urology, does not require specific

        equipment

•     The risk anastomosis stenosis is quite low.  

     Since the end of eighties almost every congress of urologic association had been published Georgian urologists publications and reports. Prof. L. Managadze and Prof. T.Chigogidze has been leading the open meeting of sessions and this was the indicator of recognition Georgian urology.