Detubularised isolated ureterosigmoidostomy (Atta pouch): Manometric and radiological studies in a sample of patients

Abstract

ObjectivesTo assess whether the detubularised isolated ureterosigmoidostomy (DIUS) technique is safe for urinary diversion after radical cystectomy.Patients and methodsThe study included 10 patients (mean age 61.8 years) with invasive bladder tumour, operated at the Alexandria University, Egypt. The diversion in all patients was through a DIUS, with ureteric reimplantation by an antirefluxing procedure, using an embedded-nipple technique. The patients were evaluated before and after surgery using radiological and manometric studies, and the results analysed statistically using Student’s t-test.ResultsNine of the 10 patients could differentiate between urinary and stool sensation, and evacuate them separately. The mean (range) daytime frequency was 4.1 (3–5) and the mean night-time frequency was 0.5 (0–1). Before and after surgery, the respective mean resting anal pressure was 71 and 74 cmH2O (P = 0.004), the volume at first desire to defecate was 54 and 72 mL (P = 0.004) and the maximum tolerable volume was 140 and 160 mL (P < 0.001). The anorectal inhibitory reflex was lost in all patients after surgery. The mean (SD, range) basal pouch pressure was 5 (3.33, 0–10) cmH2O, and the end pressure was 13.2 (4.42, 9–20) cmH2O.ConclusionAlthough the Mainz II pouch has a documented efficacy for urinary diversion after radical cystectomy, the modifications we applied to the DIUS improved that method of diversion, by separating urine and stool evacuation, maintaining continence, and with a low frequency and better protection of the upper urinary tracts, resulting in an improvement in the patients’ quality of life.

Association of spina bifida with cancer

“…Given the well-documented neoplastic risk, ureterosigmoidostomy has fallen out of favor except in carefully selected patients, and in particular is avoided in patients with benign indications for urinary diversion. Patients with ureterosigmoidostomies (or similar procedures such as the Mainz II or Atta pouches) should be evaluated annually with sigmoidoscopy, beginning 10 years after surgery (59,60). Routine biopsy is not recommended.…”