Exstrophy of the Bladder: Treatment by Trigonosigmoidostomy—Long‐term Results

Abstract

Twenty-five patients with bladder exstrophy were treated by implanting the vesical trigone into the sigmoid colon. Twenty-three have been followed for 3 to 19 years, with an average of 10 years. Taking into account the clinical status, renal function, the intravenous urogram, continence and social life, 18 patients were considered to have had an excellent result. There were 2 failures; 1 post-operative death occurred due to ruptured oesophageal varices and 1 patient developed bilateral hydronephrosis which necessitated cutaneous urinary diversion. In 4 cases the results, while satisfactory, were only fair in that 2 developed stones and 2 showed symptomatic electrolyte disturbances requiring treatment. Trigonosigmoidostomy preserves intact the ureterovesical junction which prevents colo-ureteric reflux and this probably accounts for the generally excellent long-term results. We believe the operation is preferable to ureterosigmoidostomy in the management of bladder exstrophy.

Neo-Bladder after Cystectomy

“…The ureters are then catheterized, the catheters coming out later through the primitive anus (that, at the end of the operation, will become the urinary meatus). The proximal portion of the recto-sigmoid is then turned down as a flap, reaching the lower part of the anti-mesenteric colonic incision (at the level of the muscular complex) and the two borders are sutured by a continuous suture of absorbable material, thus closing what will become the neobladder [5,6]. The proximal portion of the sigmoid is then pulled through, submucosal, within the rectum, till reaching the perineum just behind the anus, after the posterior rectal wall muscle has been split, at the upper level of the muscular complex (levators).…”

Bladder augmentation in children: where have we been and where are we going?

“…It was not until the middle of the last century that a gastrointestinal segment was used to expand a contracted bladder (usually secondary to tuberculosis or interstitial cystitis) [4]. Children (with bladder exstrophy, severe PUV, cloacal malformation and/or myelodysplasia), however, were primarily treated with urinary diversion [5–11]. Usually this meant an ileal conduit or, in the case of exstrophy, ureterosigmoidostomy (proposed a century earlier).…”