الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 140 |  |  |
| | | from | 140 | | |
Abstract
( 126 )
SUMMARY
•• _::as •••
Urinary diversion after total cystectolllJ’end by
using parts of the intesti~. could. b. done by many
different techniques according to the primary pathologio
indication for cystectomy and what part of intestine
is accessible to use in each case but non of all these
techniques could be considered as an all purpose method
of urinary diversion. But it seems that some techni,ues
are suitable for some group of population than others
according to their soci~,economic and occupational
and .syp.hilization t;actors.
from the previous study we can conclude that ure~erost.
gmatdos tcmy can not suit our farmers as the most
common indication for cystectomy.···in such cases is
bladder cancer as a late complication ot Bilharziasis
as in such cases the ureters are dilated secondary to
the pre~existing bilharzial strioture_ of the lower end
of both ureters, also there is impairment of ;renal
function due to recurrent attacks Of pyelonephritis.
The high incidence of early and late postoperative
complications particularly rapid deterioration of
( 127 )
renal function and upper tract dilatation make this
type of diversion replaced by other more sYitable
methods.
Partially excluded rectuBI_ solve the problem of
rapid upper tract dilatation. and:.reflux of faecal
matter to the upper tract and also there is voluntary
contr~l of both urinary and faecal streams, and there
is no cntact between faecal matter and the implanted
ureters so the,re is no asoending infeotion.
Also ureterosigmQidostomy with continent preanal
colostomy provides more satiSfactory results as,
complete separation of faecal and urinary streams
and voluntary contrnle of both, and another advantage
is a separate orjtice for each in a near by site to
.the original one. In some of these cases it is possible
to dif feren tiate be tween urination and d:efI’Lecatioil.,
also there is a separate urinary reservoi~ that could
be examined endoscopically if reqUired.
The rectal bladder wi th terminal left il:1ao
colostomy as a method of urinary diversion following
(12~ )
’cystectomy for cancer waS fovoured on the basis of its
technical simplicity and that it does not re~uire the
application of a sophisticated collecting device.
The operation is applied large~y to farmers for
who me if. an ileal conduit diversion is elected, the
supply of such appliance is difficult in view of the
economic costs involved as well as the difficulty of
providing proper care of the stoma. The two main
drawbacks of this procedure which are recurrent
pyelonephritis and nocturnal urinary leakage could
be o’ve.rc omed by:
The ant irefluxing ureterorectal anastomosis
prevents ascending infection and preserve nephron
integrity.
Imipramine hydrochloride proved to be efficient
in control of nocturnal urinary leakage so it is
concluded that the rectal bladder with a terminal
cololltomy ill a highly reoommended method for urinary
diversion when these 2 modification are ac~1eved.
Ileocaecal bladder also give good results but it
does not suit our farmers as intermittent catheterisation
is required and special care of the stoma is
secessary.
( l~ )
Ureteroenterocutaneous conduit diversion using
either ileal oonduit or colonic conduit provides
satisfactory ~.sults but necessitate wearing ot an
external collecting device which is socioeconomically
not preferred in rural countries.
The 2 main dr~back~ of ileal loop conduit are
stomal stenosis and reflux resulting in upper tract
dilatation and recurrent pyelonephritis and deterior~
ation of renal function. but stomal stenosis is minimal .
in colonic crudiut. reflux is prevented by using
antireflux submucosal tunnel.
Another advance~ent in preventing reflux is the
utilisation of ileocaecal segment as a conduit and the
ileocaecalvalve as a non refluxing val.e thus avoiding
upper tract deterioration and recurrent attacks ot
pyelonephritis.