Continent urinary diversion in patients with pelvic irradiation: an alternative utilizing transverse colon reservoir.

The use of radiation therapy in pelvic malignancies increases the risk of urinary complications, sometimes being necessary urinary diversion. The risk of utilizing previously irradiated bowel should be avoided. The use of transverse colon is a safe and effective alternative. We present a heterotopic continent colonic reservoir with an easily catheterizable conduit.

Transverse colon for continent urinary diversion: experimental study comparing two techniques.

OBJECTIVES: Patients who have undergone pelvic radiotherapy can develop urinary complications such as actinic cystitis or fistulas and ultimately need urinary diversion, for which several techniques have been described. The purpose of this experimental study was to compare 2 different types of continent urinary diversion with the colonic pouch. METHODS: Sixteen dogs of both sexes, weighing 20-25 kg were divided into 3 groups: the pilot group consisted of 6 dogs used to standardize the technique. Group 1 consisted of 5 dogs that underwent the Monti technique to construct the conduit and the Abol-Eneim technique to promote continence. The final group, group 2, consisted of 5 dogs that underwent the intussusception technique for continence. In both techniques the same length of colon was used (20 cm). Urodynamic evaluation was performed at postoperative day 30. RESULTS: The compliance of the reservoir was similar among the groups. The capacity of the reservoir was greater and the continence mechanism was more effective in group 1. The length of the conduit was also longer in group 1. In group 2, the intussusception's mechanism was totally lost in 1 dog and partially in 2. CONCLUSIONS: The technique performed in group 1 allowed for the construction of a reservoir with greater capacity and the continence mechanism proved to be more efficient than in group 2. The length of the conduit was significantly greater in group 1.

Valvula de uretra posterior. / Posterior urethra valve

Os autores analisam os resultados referentes a 29 pacientes portadores de valvula de uretra posterior. A maior parte dos casos era de criancas brancas, de baixa faixa etaria nas quais havia maior comprometimento do estado geral. A sintomatologia estava relacionada a quadros infecciosos e obstrutivos. O trato urinario superior apresentou-se alterado em 65% dos casos, havendo refluxo vesico-ureteral em 31%.Doze pacientes apresentavam-se em mau estado geral, mas somente 9 foram submetidos a derivacao do tratao urinario, sendo que 3 faleceram logo apos a admissao no hospital. Todos os pacientes apresentaram melhora progressiva do trato urinario superior apos o tratamento da Valvula de Uretra Posterior. Dois pacientes necessitaram correcao cirurgica do refluxo vesico-ureteral

Consideraçöes sobre a indicaçäo de derivaçäo urinária em pacientes com neoplasia em estádios avançados / Indication of urinary diversion in patients with neoplasm in advanced stages

No período de 1976 a 1981, 17 pacientes foram submetidos à derivaçäo urinária, em conseqüência de obstruçäo ureteral bilateral, secundária a processo neoplásico. Os casos de carcinoma do colo uterino tiveram sobrevida mediana de 8 meses e os portadores de carcinoma vesical a sobrevida mediana foi de 10 dias. O carcinoma do colo uterino foi a neoplasia mais freqüente e que apresentou maior e melhor sobrevida quando submetida à derivaçäo urinária