Short- and long-term results of ureterosigmostomy with creation of Mintz pouch II and Hasan reservoir
Urology №2 2004
Darenkov S. P., Sokolov A. E., Ochcharkhadzhiev S. B.
The aim of the study was analysis of short- and long-term results of treating patients operated with intestinal replacement of the urinary bladder by Mintz pouch II and Hasan. Thirty-two ureterosigmostomies with creation of the reservoir from the rectosigmoid angle (17 Mintz pouch II and 15 Abol-Enein operations) were made from 1997-2002.
The age of the patients ranged from 16 to 73, the follow-up was 12-72 months. The operation was indicated in infiltrative cancer of the urinary bladder, microcystis of various etiology, extrophy of the urinary bladder. Postoperative urine retention was observed in all the patients both in the day and night time. Renal function remained unchanged or improved in 93% patients. Quality of life was good. All the patients except two with recurrent attacks of pyelonephritis were socially adapted. Able patients resumed their jobs. Early after the operation one woman developed incompetence of the sutures of the reservoir anterior wall which required relaparotomy. Four patients died of local recurrence and/or distant metastases in different terms after surgery. Two patients had reflux with frequent attacks of pyelonephritis as well as a serious impairment of acid-base balance manifesting as hyperchloremic acidosis, the other two patients had late unilateral strictures of the intestinoureteral anastomosis which was reestablished. Thus, updated ureterosigmostomy significantly reduces the rate of complications and is a good alternative to heterotopic and ortotopic urine derivation in contraindications for the operations. Moreover, Hasan’s operation allows implantation of delated ureters. In most cases, ureterosigmostomy with formation of reservoir from rectosigmoid angle provides good quality of life in adequate selection of patients.