Urinary diversion via a continent ileal reservoir has been performed in 12 patients. An isolated ileal reservoir was constructed using the technique described for patients with a continent ileostomy. The ureters were implanted into an afferent segment provided with a reflux-preventing nipple valve. There were few operative complications and no operative mortality. Late complications involving malfunction of the nipple valves occurred in 8 patients and were corrected surgically. Postoperative followup presently is between 9 months and 6 1/2 years. Two patients have died: 1 in an accident and 1 of metastatic bladder carcinoma. The remaining 10 patients are continent and without reflux to the upper urinary tract. The reservoir generally is emptied by intermittent self-catheterization between 3 to 6 times daily. The volume capacity of the reservoir is more than 500 ml. Urinary cultures have been constantly negative in 7 patients and the contents of the reservoir more or less permanently contained bacteria in 5. Dilatation of the upper urinary tracts, progressive renal deterioration or metabolic disturbances have not been encountered. All patients are satisfied with this type of urinary diversion, especially those who have undergone other types of diversion previously.
A new method for urinary diversion to the rectum was elaborated in animal experiments and currently has been used in 19 patients. Reflux of the rectal content to the colon and to the upper urinary tract is prevented by the fashioning of an intussusception valve at the rectosigmoid junction. The rectum is augmented by anastomosing an ileal patch to the anterior rectal wall. A transverse colostomy protects the construction for 6 to 8 weeks. Of the 19 patients 3 had local recurrence or metastasis within 6 months. Thus, 16 patients with a followup of 3 to 14 months are evaluable. All patients are continent during the daytime with an emptying frequency of 3 to 5 times and dry at night with a frequency of 0 to 2. In 3 patients partial sliding of the sigmoid intussusception valve occurred causing reflux of rectal contents to the sigmoid and to the right ureter in 1. Reflux to the upper urinary tract has not been revealed in any of the other patients. With 1 exception excretory urography has demonstrated either improvement or stabilization of the upper urinary tract post-operatively. The rectal capacity increased from 200 to 700 ml. after 6 months. With the reservoir full the mean basal pressure was 17 cm. water and the mean maximum pressure was 24 cm. water.
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