During the last 16 years (1960 to 1976) we have treated 78 patients with a contracted bladder syndrome, 40 of whom have been treated surgically by replacing part or all of the bladder with an isolated segment of rectosigmoid, cecum or ileum. The series is a combination of 30 patients treated by Shirley in the United States and 10 patients by Mirelman in South America. Chronic interstitial cystitis (26 cases) and chronic radiation cystitis (4 cases) have been the primary causes for surgical treatment of the contracted bladder in the United States, whereas tuberculosis of the urinary tract was the primary etiologic factor for those treated in South America. The results have been gratifying, with 50 per cent excellent and 30 per cent good. Only 3 patients have had to be diverted to and outside colon or ileal conduit. Generally, our results with each type segment of large and small bowel have been satisfactory by the choice of segment must depend on the degree of bladder disease, and the medical and urologic condition of the patient.
Intravesical dimethyl sylfoxide has given satisfactory symptomatic relief in 75 per cent of patients with interstitial cystitis so treated. The treatment is simple and inexpensive, and can be safely administered as an office procedure. Objective improvement in the endoscopic appearance of the disease, with improvement in bladder capacity, was noted in 80 per cent of the patients in our series. Further work with dimethyl sulfoxide is indicated in the treatment of interstitial cystitis, as well as a variety of other genitourinary disorders.
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