الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Although orthotopic substitution of the bladder is considered the optimal method of urinary diversion following
cystectomy, the procedure may not be applicable In a
significant proportion of cases : including patients with a
pathological condition of the urethra or a high Iikehoad of
urethral recurrence. In such circumstances an anal sphincter
controlled bladder substitute provide a viable alternative.
A multitude of techniques have been described to divert
the urinary stream to the rectum. It is clear that the overall goal
of such procedure is the storage of urine under low pressure
conditions. Unfortunately, the classical techniques of
ureterosigmoidostomy as well as rectal bladder do not permit
low pressure storage because the intestine is left intact.
In the present study 81 patients were undergone radical
cystectomy and two methods of diversion have been utilized,
ureterosigmoidostomy and sigma rectum pouch.
Ureterosigmoidostomy. group, the first group, included 42
patients, 9.6% were females with mean age 57.17 + 8.009.
The sigma pouch group, the second group, were 39
patients, 20.5% were females with mean age 53.85 + 7.38 .
Sigma pouch have been done by folding the sigmoid
into U shaped configuration or by double folding into N shaped
configuration the ureters were implanted by the submucous
tunnel technique in cases of ureterosigmoidostomy and in the U
shaped sigma pouch. Extramural serous lined tunnels technique
were used in the double folded N shaped pouch.
Mortality rate in the early post operative was 4.8% in the
ureterosigmoidostomy group and 5.1 % in the sigma pouch
group. In the late post operative evaluation mortality was 22.5%
in the first group and 11.4 % in the sigma pouch group. Tumour
recurrence was the main cause of death in the both groups.
The major early complications reported In the
ureterosigmoidostomy group and the sigma pouch group were
respectively : urinary leakage 16.7 % and 10.3%, fecal leakage
0% and 5.1 %, ureteric obstruction 9.5 % and 2.6%, ureteric
reflux 4.8 % and 0% ,acute episodes of pyelonephritis 11.9%
and 5.1 % and wound infection was 19.% and 17.9 % .
The late complications in the both groups were :
ureterocolic obstruction 12.5% and 11.4 %, ureterocolic reflux
5% and 8.6%, chronic pyelonephritis 17.5 % and 11.4% , renal
function deterioration 10% and 5.7 % , tumour recurrence 15 %
and 8.6 % , renal calculi 2.5 % and 5 %, lastly metabolic
acidosis was 20 % in the first group and 0 % in the sigma group.
Radiological reno-ureteral pattern was stabilized in
73.75% in the ureterosigmoidostomy group and in 87% in the
sigma pouch group
Daytime continence was achieved In 87.5%in the
ureterosigmoidostomy group and 100% in the second group
.Night continence was 72.5% and 88.5% in the two groups
respectively . Enuretic patients were 3 patients 7.5% in the first
group and in one patient 2.8% in the second group.
Pouchmetry and pouchgram have been evaluated in sigma
pouch group with mean capacity 656.206 cc + 120.9 and mean
pressure 20.038 ern of water + 3.02 . There is no significant
difference among U shaped and N shaped double folded pouch
configuration.
The study of blood urea and serum creatinine in uretero
sigmoidostomy group revealed that higher values will be
resulted at prolonged time of evaluation and no significant
difference have been illustrated in the sigma pouch group .
The sigma rectum pouch has many advantages over other
forms of continent urinary diversion. A reservoir capacity, safe
and stable pouch fixation without the risk of damaging the
mesentry in the area of the promontory , guaranteeing a straight
ureteral path and low pressure even at high filling volumes make
the sigma rectum pouch a most attractive urinary diversion.
Simple detubularization without the need for extensive
bowel surgery or colostomy suffices to create a low pressure
reservorr . With this technique even dilated ureter can be
implanted . This technique improves continence and protecting
the upper urinary tract . It is an elegant and simple method to
create a low pressure reservoir.