Rectal Vesico-urethroplasty updated with Ten Years' Evaluation

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Abstract
A new operation--rectal vesico-urethroplasty--has been designed to reproduce the normal anatomy and physiology of the lower urinary tract after total cystectomy. This is achieved by using the rectum with its intact nerve supply to replace the bladder and posterior urethra, thereby ensuring the known requirements for normal bladder function, viz, an adequately contractile reservoir with a sphincteric outlet and an intact corticospinal nerve tract. The operation has been carried out on 126 patients, 114 males and 12 females. It has been performed as an immediate sequel to cystectomy in 111 cases and as a secondary reconstruction after previous cystectomy and diversion in 15 cases. The results are greatly superior to colocystoplasty: most patients enjoy practically normal continence and voiding and are not threatened by subsequent complications. The postoperative mortality rate of 17% in the present series is largely due to avoidable factors and has markedly reduced in the last group of cases.