Urinary undiversion from a sigma-rectum pouch to a cutaneous urinary stoma as a treatment for severe metabolic disorders post-radical cystectomy: A case report

Abstract

A total of six male patients, who had undergone radical cystectomy and sigma-rectum pouch surgery due to bladder cancer (2–5 years previously), developed hyperchloremic metabolic acidosis, hypokalemia and renal dysfunction. The patients underwent urinary undiversion surgery (the pouch was isolated from the intestinal tract, abdominal ostomy was performed, and the sigmoid colon and rectum were reconnected) and blood gas and electrolyte analysis and renal function were compared pre- and post-surgery. Blood hydrocarbonate levels significantly improved 3 months post-surgery compared with the preoperative levels (17.90±4.12 vs. 7.57±4.25; P=0.026). At 6 months post-surgery, blood pH (7.36±0.04 vs. 7.16±0.08; P=0.028) and potassium levels (3.95±0.38 vs. 3.12±0.21; P=0.032) were found to have improved significantly compared with the pre-surgery levels, and remained normal. Serum creatinine levels decreased significantly from the preoperative levels at 6 months post-surgery (213.00±44.85 vs. 304.67±55.58; P=0.028). Serum chlorine (99.17±2.75 vs. 110.90±4.38; P=0.038) significantly improved until 3 years post-surgery. The results of this case report indicated that urinary undiversion from a sigma-rectum pouch to a cutaneous urinary stoma that separates the pouch and intestine may be a beneficial treatment for post-sigma-rectum pouch surgery acidosis and electrolyte disturbances.

Robot‐assisted radical cystectomy with intracorporeal Mainz Ⅱ rectosigmoid pouch for muscle‐invasive bladder cancer

“…The major limitation is that metabolic disorders, anastomotic stricture and malignant transformation of uretero-intestinal anastomosis can occur. 9,16,17 The goals for improving urinary diversion are to decrease the incidence rates of complications and allow patients to achieve a high QOL. 16 The decision process involves the consideration of issues related to the cancer stage, patient comorbidities, treatment needs, and patient desires.…”

“…9,16,17 The goals for improving urinary diversion are to decrease the incidence rates of complications and allow patients to achieve a high QOL. 16 The decision process involves the consideration of issues related to the cancer stage, patient comorbidities, treatment needs, and patient desires. Until now, ideal urinary diversion had not been developed.…”