1165 COMPARISON OF MANOMETRIC AND RADIOLOGIC FINDINGS IN SIGMA VS. DETUBULARIZED ISOLATED URETEROSIGMOIDOSTOMY (ATTA POUCH)

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You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20121165 COMPARISON OF MANOMETRIC AND RADIOLOGIC FINDINGS IN SIGMA VS. DETUBULARIZED ISOLATED URETEROSIGMOIDOSTOMY (ATTA POUCH) Tamer Abou Youssif, Grgs Fawzy, Wael Sameh, and Mohammed Atta Tamer Abou YoussifTamer Abou Youssif Alexandria, Egypt More articles by this author , Grgs FawzyGrgs Fawzy Alexandria, Egypt More articles by this author , Wael SamehWael Sameh Alexandria, Egypt More articles by this author , and Mohammed AttaMohammed Atta Alexandria, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1389AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detubularized Isolated Ureterosigmoidostomy (DIUS) involves detubularization of the rectum and sigmoid colon and refashioning into an isolated pouch with fixation of the new non-dismembered left colon stoma into posterior rectal wall facing the anal canal (Atta MA, J Urol, 1996). Improvement bowel evacuation pattern, and absence of urgency and nocturnal wetting was shown in a previous study. The present study provides rectodynamic as well as radiologic evidences for improved function following DIUS. METHODS This study was conducted on 20 patients divided into two groups: group(A) including ten patients scheduled for radical cystectomy and urinary diversion by DIUS, and group (B) including ten patients who had previously underwent radical cystectomy and urinary diversion by sigma rectum pouch (Mainz II). The rectal and anal pressures as well as the anorectal inhibitory reflex were measured preoperatively and repeated 6 months in both groups. Ascending pouchography was done postoperatively with incremental increase of the infused volume till 500 ml, and post-evacuation film was taken to confirm complete colon evacuation. Comparison of both groups was done using Student t-test. RESULTS In group A there was a statistical significant difference between preoperative and postoperative mean resting anal pressure, which was 71 ± 4.007 (66-80) cmH2O and 73.9 ± 4.42 (69-83) cmH2O respectively. There was no significant difference between post-operative mean resting anal pressure in group A and B. In group A the mean basal pouch pressure was 5 ± 3.33 (0-10) cmH2O, mean end pressure was 13.2 ± 4.42 (9-20) cmH2O and contraction waves were found in one patient with pressure up to 40 cmH2O. In group B the mean basal pouch pressure was 7 ± 2.58 (5-10) cmH2O, mean end pressure was 17.7 ± 6.11 (10-30) cmH2O and contraction waves were found in three patients with pressure up to 40 cmH2O The anorectal inhibitory reflex was lost in all patients of group A after surgery. All patients of group B showed preserved anorectal reflex. Pouchogram with a maximum infused volume of 500 ml showed no reflux to the colon or the ureters in group A, with full emptying on post evacuation films. In group B eight patients had reflux up to the transverse colon starting at 350 ml and became more evident at 500 ml in all patients, with failed emptying post evacuation films. CONCLUSIONS Detubularization of the rectum and sigmoid results in a capacious low pressure pouch with absent anorectal inhibitory reflex, consequently decreasing the frequency of evacuation without any urgency. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e472 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tamer Abou Youssif Alexandria, Egypt More articles by this author Grgs Fawzy Alexandria, Egypt More articles by this author Wael Sameh Alexandria, Egypt More articles by this author Mohammed Atta Alexandria, Egypt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...