|Title:||La sigmoidoplastia distal destubulizada. Descripción de la técnica||Authors:||Isorna Martínez De La Riva, Santiago||Issue Date:||1996||Publisher:||0004-0614||Journal:||Archivos españoles de urología||Abstract:||OBJECTIVES: To describe a new technique for orthotopic bladder replacement using a short detubularized segment of the most distal portion of the sigmoid colon, termed 'detubularized distal sigmoidoplasty'. METHODS: The surgical technique utilized 1) large bowel to provide a larger intestinal lumen, stronger muscle layer and minimum metabolic activity; 2) a short segment providing adequate volume in the sigmoid and a reduced surface of exchange; and 3) a distal segment close to the urethra so it can be easily advanced without stretching and with minimum sectioning of the mesosigmoid. A short segment (approximately 18 cms) of the distal sigmoid is separated with minimum mobilization of the mesentery. It is detubularized to obtain a centrally located rectangle. The ureter is reattached using the antireflux technique of direct retrögrade submucosal tunneling with a symmetrical pseudotrigonal arrangement. The reservoir is constructed using a single transverse continuous suture that is interrupted 2 cms before complete closure of the neobladder to provide an orifice for urethral anastomosis. RESULTS: The technique is simple and utilizes a segment shorter than those described to date. Any segment of the sigmoid can be utilized. The neobladder can be shaped with a single continuous suture and the ureter can be reinserted in a more anatomic position. The reservoir has an adequate volume of approximately 300 cc. Voiding is accomplished by contraction of the reservoir and abdominal pressure. CONCLUSIONS: This neobladder technique is simple. It achieves excellent diurnal continence and maintains the contractile capacity which permits comfortable and compensated voiding.||URI:||http://hdl.handle.net/10553/48859||ISSN:||0004-0614||Source:||Archivos Espanoles de Urologia[ISSN 0004-0614],v. 49, p. 657-667|
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