Remodeled Right Colon: An Alternative Urinary Reservoir

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Abstract
A total of 11 patients underwent bladder substitution of continent supravesical diversion with a remodeled right colonic segment as a urinary reservoir. Of the patients 1 woman and 2 men had bladder substitution: in 2 the bladder neck and urethra were preserved, and in 1 man radical cystoprostatectomy with preservation of the distal sphincteric mechanism was performed. All 3 patients currently are continent. In the 8 diversion patients an anti-incontinence mechanism was reconstructed with a segment of plicated ileum sutured to the abdominal wall. Six patients are completely dry between catheterizations every 4 to 6 hours, 1 man requires more frequent catheterizations, and the woman has refused self-caheterization and wears an external appliance. There were 18 ureterointestinal reimplantations performed successfully for upper tract protection, and 1 ureterocolonic reimplantation became partially obstructed and required percutaneous dilation. Reflux did not occur. This remodeled right colonic segment, reconstructed with interruption of the intestinal circular fibers, allows for storage of large urine volumes at reasonable pressures and it is a suitable alternative bladder substitution procedure. Plicated ileum has allowed for easy catheterization and it has been an adequate anti-incontinence mechanism when associated with this colonic reservoir.