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 Pagei

Urinary Diversion

SecondEdition
 Pageii

This page intentionally left blank.

 Pageiii

Urinary Diversion
SecondEdition
Edited by

KarlJKrederMDFACS

ProfessorandClinicalViceChair,DirectorofUrodynamicsand
ReconstructiveUrology,DepartmentofUrology
UniversityoflowaHospitalsandClinics,lowaCity,IA,USA

AnthonyRStoneMD

ProfessorandViceChair,DirectorofUrology,DepartmentofUrology
UniversityofCalifornia,Davis,SacramentoCA,USA

LONDONANDNEWYORK
AMARTINDUNITZBOOK
 Pageiv

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 Pagev

Contents

ListofContributors viii
Foreword xiii
Acknowledgements xiv
PrefacetotheSecondEdition xv
PrefacetotheFirstEdition xvi

SECTION I:INTRODUCTION

1. Historyofurinarydiversiontechniques 1
George D Webster and Andrew C Peterson
2. Anatomyofthestomach,smallandlargebowelasitappliestourinarytractreconstruction 21
Jacob Ramon

SECTION II:PHYSIOLOGICALCONSIDERATIONSOFTHEUSEOFBOWELSEGMENTSINTHEURINARYTRACT

3. Metabolicimplicationsandelectrolytedisturbances 29
Cigdem Tanrikut and W Scott McDougal
4. Themechanicsoftubularanddetubularizedbowelforbladdersubstitution 35
Morten Colding­Jørgensen and Kenneth Steven
5. Bacteriuriainpatientswithreconstructedlowerurinarytracts 43
Björn Wullt and Wiking Månsson
6. Structuralandfunctionalchangesofthegastrointestinalmucosaincontactwithurine 53
Wiking Månsson, Thomas Davidsson and Roger Willén
7. Renalfunctionconsiderationsinbladdersubstitution 67
Jens Christian Djurhuus, Troels Munch Jørgensen and Jørgen Frøkiær
8. Bonemineralizationafterurinarydiversion 81
Thomas Davidsson, Karl Obrant, Birger Lindergård
9. Problemofsecondarymalignancyafterurinarydiversionandcystoplasty 91
Jerilyn M Latini and Karl J Kreder
10. Effectofenterocystoplastyonskeletaldevelopmentinchildren 109
Mike Minh Nguyen and Eric A Kurzrock
1. Boweldysfunctionfollowingenterocystoplasty 15
Stephen D Mark and George D Webster

SECTION III:ORTHOTOPICBLADDERREPLACEMENT

12. Nomenclatureclassificationofurinarydiversion 12
Christopher Chapple and Richard Turner­Warwick
13. Patientselectioncriteriafororthotopicbladderreplacement 129
Steven R Mindrup and Badrinath R Konety
 Pagevi

14. Ilealneobladders:CameyII,Hautmann,Kock 135

E James Wright
15. Ilealreservoir 143
Fiona C Burkhard, Celi Varol and Urs E Studer
16. Ileocolonicreservoirs:OrthotopicMainzPouchI,LeBag 15
Joachim W Thüroff
17. Bladderreplacementwithdetubularizedrightcolon 16
Tamsin Greenwell, Daniela Andrich and Anthony Mundy
18. Sigmoidneobladder 17
Jerilyn M Latini
19. Thegastriccontinenturinaryreservoir 179
Pasquale Casale, Mark Horowitz and Michael E Mitchell
20. Orthotopicbladderreplacementinwomen 189
Cheryl T Lee and James E Montie
21. Bowelandbladderreplacementaftertotalpelvicexenteration 197
Anne K Schuckman, John Stein and Donald G Skinner
2. Voidingfunctionandcontinencefollowingorthotopicdiversion 205
Kilian Walsh

SECTION IV:CONTINENTURINARYDIVERSIONTOANABDOMINALSTOMA

23. ThecontinentKockand ­ pouch

T reservoirs:crossovertechniques 213
John P Stein and Donald G Skinner
24. Continenturostomywithhydraulicvalve 235
Abdellatif Benchekroun
25. Rightcolonreservoirusingataperedilealoutlet 243
Randall G Rowland and Andrew C McGregor
26. TheMitrofanoffprincipleincontinenturinarydiversion 253
Christopher S Cooper and Howard M Snyder, III
27. InsitumodificationoftheMitrofanoffprincipleinadultpatients 261
Elmar W Gerharz and Hubertus Riedmiller
28. TheMontiprincipleincontinenturinarydiversion 269
Padraig S J Malone, Ramesh Babu and Martin A Koyle

SECTION V:TECHNIQUESTHATUSETHEANUSFORCONTINENCE

29. UreterosigmoidostomyandMainzpouchII 275

Margit Fisch, Joachim W Thüroff and Rudolf Hohenfellner
30. Urinarydiversiontothemodifiedrectalbladder: ­ controlled
ananalsphincter
bladdersubstitute 285
Hassan Abol­Enein and Mohamed A Ghoneim
 Pagevii

SECTION VI:PREVENTIONOFREFLUX

31. Isrefluxpreventionnecessaryinurinarydiversion? 297

Michael L Guralnick
32. Refluxpreventionwithintussusceptednipplevalvesandtunnels 307
Arthur C Grabowski and Lesley K Carr
3. TheLeDuc — Cameymethodforrefluxprevention 319
Alain Le Duc and Maurice Camey
34. Useofthesplit­ cuffnippletechniqueforureteralreimplantation 325
Regina Hovey and Anthony R Stone

SECTION VI:CONDUITURINARYDIVERSION

35. Ilealconduiturinarydiversion 31
Christopher E Iselin
36. Colonconduitdiversionandspecialconsiderationsinradiatedpatients 34
Joseph A Costa
37. Specialconsiderationsinneurogenicbladderpatients 349
Thiagarajan Nambirajan and Ian K Walsh
38. Troubleshootingtheproblematicpatientafterconduiturinarydiversion 35
Vincent Tse
39. Laparoscopicbladderaugmentationandurinarydiversion 36
Raymond R Rackley, Joseph B Abdelmalak, Ahmed S El­Azab, Sandip P Vasavada and Inderbir S Gill

Index 37
 Pageviii

Contributors
Joseph B Abdelmalak MD
Glickman Urologic Institute
Cleveland Clinic Foundation
Cleveland, OH, USA

Hassan Abol­Enein MD PhD

Professor of Urology
LJrology and Nephrology Center
Mansoura, Egypt

Daniela Andrich MD MRCS

Institute of Urology
London, UK

Ramesh Babu MS MCH FRCS (Paeds)

Specialist Registrar in Paediatric Urology
Department of Paediatric Urology
Wessex. Regional Centre for Paediatric Surgery
Southampton University Hospitals NHS Trust
Southampton, UK

Abdellatif Benchekroun MD
Professor
Department of Urology
Hospital Avicenne
Rabat R.P., Morocco

Fiona C Burkhard MD
Department of LJrology
University of Berne
Inselspital­Anna Siler­Haus
Berne, Switzerland

Maurice Camey
Professor of Urology (retired)
Paris, France

Lesley K Carr MD FRCS(C)

Medical Director, Women’s Pelvic Health Centre
Division of Urology
Sunnybrook and Women’s College Health Science Centre
Toronto, Ontario, Canada

Pasquale Casale MD
Assistant Professor of Urology
University of Pennsylvania
Children’s Hospital of Philadelphia
Division of Pediatric Urology
Philadelphia, PA, USA

Christopher Chapple BSc MD FRCS(Urol)

Consultant Urological Surgeon
Department of Urology
Royal Hallamshire Hospital
Sheffield, UK

Lise L Christensen MD
Institute of Experimental Clinical Research and Department of
Urology
Skejby Hospital
University Hospital in Aarhus
Aarhus, Denmark

Morten Colding­Jørgensen MD MSc

Department of Medical Physiology
The Panum Institute
University of Copenhagen
Copenhagen, Denmark

Christopher S Cooper MD
Associate Professor
Director, Pediatric Urology
The University of Iowa
Iowa City, IA, USA

Joseph A Costa MD
Assistant Professor of Surgery
University of Florida College of ‘Medicine
Head, Section of reconstructive Surgery and Neuourology
University of Florida shands Jacksonville
Jacksonville, FL, USA

Thomas Davidsson MD PhD

Associate Professor
Department of Urology
University Hospital Lund
Lund, Sweden

Jens Christian Djurhuus MD

Professor of Clinical Surgery
Institute of Experimental Clinical Research
University of Aarhus
DK­8200 Aarhus North
Denmark

Ahmed S El­Azab MD
Clinical Research Fellow
Section of Female Urology and Voiding Dysfunction
Glickman Urologic Institute
Cleveland Clinic Foundation
Cleveland, OH, USA
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 Pageix

Margit Fisch MD
Professor of urology
Center of Urology and Pediatric Urology Hamburg
Allgemeines Krankenhaus Harburg
Hamburg, Germany

John A Freeman MD
Medical Director
Nevada Urology Associates
Reno, NV, USA

Jorgen Frokiaer MD
Consultant in Clinical Physiology
Institute of Experimental Clinical Research
Department of Clinical Physiology/Nuclear Medicine
Skejby Hospital
University Hospital in Aarhus
Aarhus, Denmark

Elmer W Gerharz MD
Associate Professor of Urology
Department of Urology
Julius Maximilians­University Medical School
Würzburg, Germany

Mohamed A Ghoneim MD PhD

Urology and Nephrology Center
Mansoura University
El Mansoura, Egypt

Inderbir S Gill MD MCh

Glickman Urologic Institute
Cleveland Clinic Foundation
Cleveland, OH, USA

Arthur C Grabowski MD
Sunnybrook & Women’s College
Health Science Center
Toronto, Ontario, Canada

Tamsin Greenwell MD FRCS (Urol)

Consultant Urological Surgeon
Institute of Urology
London, UK

Michael Guralnick MD FRCSC

Assistant Professor
Department of Urology
Medical College of Wisconsin
Milwaukee, WI, USA

Rudolf Hohenfeller MD
Head Professor of Urology
University of Mainz
Department of LJrology
Mainz, Germany

Mark Horowitz MD
Assistant Professor, Pediatric Urology
Director, Pediatric Voiding Dysfunction Center &
Urodynamics Laboratory
Weill Medical College of Cornell University
New York Presbyterian Hospital
New York, NY, USA

Regina Hovey MD
UCI Medical Center
University of California
Irvine, CA, USA

Christopher Iselin MD
Clinique D’Urologie
Geneva, Switzerland

Troels Munch Jørgensen MD

Department of Urology
Section of Pediatric Urology
Aarhus University Hospital
Aarhus, Denmark

Badrinath Konety MD MBA

Assistant Professor of Urology and Epidemiology
Department of Urology
University of Iowa
Iowa City, IA, USA

Martin A Koyle MD
Professor or Surgery and Paediatrics
Chairman, Department of Paediatric LJrology
University of Colorado Health Sciences Center and
The Children’s Hospital
Denver, CO, USA

Karl J Kreder MD FACS

Professor and Clinical Vice Chair
Director of Urodynamics and Reconstructive Urology
Department of Urology
University of Iowa Hospitals and Clinics
Iowa City, IA, USA

Eric A Kurzrock MD
Assistant Professor of Pediatrics and Urology
Chief of Pediatric LJrology
University of California Davis Children’s Hospital
Department of Urology
Sacramento, CA, USA

Jerilyn M Latini MD
Fellow, Female and Reconstructive Urology
Department of Urology
University of Iowa
Iowa City, IA, USA
 Pagex

Alain LeDuc MD
Professor of Urology
Service D’Urologie
Hopital Saint­Loise
Paris, France

Cheryl T Lee MD
Assistant Professor of Urology
Gomprehensive Cancer Center
University of Michigan
MI, USA

Birger MD PhD
Associate Professor
Department of Nephrology
Lund University Hospital
Lund, Sweden

Padraig SJ Malone MCh FRCSI FRCS

Consultant Paediatric Urologist
Department of Paediatric Urology
Wessex Regional Centre for Paediatric Surgery
Southampton University Hospitals NHS Trust
Southampton, UK

Wiking Månsson MD PhD

Consultant Urologist
Associate Professor
Department of Urology
Lund University Hospital
Lund, Sweden

Stephen D Mark MD
Urologist
Christchurch Hospital
Department of Urology
Christchurch, New Zealand

W Scott McDougal MD
Chief of Urology
Department of LJrology
Massachussets General Hospital and
Walter S Kerr Jr Professor of Urology
The Harvard Medical School
Boston, MA, USA

Andrew C McGregor MD
Urology Resident
University of Kentucky
School of Medicine
Lexington, KY, USA

Steven R Mindrup MD
Resident in Urology
Department of Urology
University of Iowa
Iowa City, IA, USA

Michael E Mitchell MD
Professor, University of Washington
Chief, Division of Pediatric Urology
Children’s Hospital and Regional Medical Center
Seattle, WA, USA

James E Montie MD
Chairman, Department of Urology
Valassis Professor of Urologic Oncology
University of Michigan
Department of Urology
Taubman Center
Ann Arbor, MI, USA

Anthony Mundy MS MRCP FRCS

Institute of Urology
London, UK

Thiagarajan Nambirajan MS DNB MCh (Urol) FRCSUrol

Specialist Registrar in Urology
Regional Urology Service
Belfast City Hospital
Belfast, Northern Ireland

Mike Minh Nguyen MD

Resident Physician
Department of Urology
University of California
Davis School of Medicine
Sacramento, CA, USA

Karl Obrant MD PhD

Professor
Department of Orthopedics
University Hospital MAS
Malmö, Sweden

Andrew C Peterson MD
Chief
Reconstructive Urology
Female Urology and Urodynamics
Department of Surgery
Urology Service
Madigan Army Medical Center
Fort Lewis, WA, USA
 Pagexi

Raymond Rackley MD
Glickman Urologic Institute
Cleveland Clinic Foundation
Cleveland, OH, USA

Jacob Ramon MD
Consultant Urologist
The Chaim Sheba Medical Center
Tel­Hashomer, Israel

Hubertus Riedmiller MD
Professor of Urology
Chairman, Department of Urology
Julius Maximilians­University Medical School
Würzburg, Germany

Randall G Rowland MD PhD

Professor and James F Glenn Chair of Urology
University of Kentucky
School of Medicine
Lexington, KY, USA

Anne K Schuckman MD
University of Southern California
Norris Cancer Center
Department of LJrology MS74
Los Angeles, CA, USA

Donald G Skinner MD
University of Southern California
Norris Cancer Center
Department of Urology MS74
Los Angeles, CA, USA

Howard M Snyder III MD

Division of Pediatric Urology
Wood Building Children’s Hospital
Philadelphia, PA, USA

John Peter Stein MD

University of Southern California
Norris Comprehensive Cancer Center
Los Angeles, CA, USA

Kenneth Steven MD DMSci

Chief Urologist
Department of Urology
Herlev Hospital
University of Copenhagen
Herlev, Denmark

Anthony R Stone MD
Professor and Vice Chair
Director of Urology
Department of Urology
University of California
Davis
Sacramento, CA, USA

Urs E Studer MD
Department of Urology
University of Berne
Inselspital
Berne, Switzerland

Cigdem Tanrikut MD
Department of Urology
Massachussets General Hospital and
The Harvard Medical School
Boston, MA, USA

Joachim W Thüroff MD
Johannes­Gutenberg University
Department of LJrology
Mainz, Germany

Vincent Tse MB BS (Hons) MS FRACS

Consultant Urologist
Concord Hospital
Sydney, Australia

Richard Turner­Warwick CBE FRCP FRCS FRCOG

formerly Senior Surgeon and Urologist to The Middlesex.
Hospital and St Peters Hospitals and Hunterian Professor
Royal College of Surgeons (1992)
London, UK

Celi Varol
Department of Urology
University of Berne
Inselspital­Anna Siler­Haus
Berne, Switzerland

Sandip P Vasavada MD
Glickman Urologic Institute
Cleveland Clinic Foundation
Cleveland, OH, USA

Ian K Walsh MD FRCSUrol

Consultant Urologist and Neurologist
Department of Urology
Belfast City Hospital
Belfast, UK
 Pagexii

Kilian Walsh MB FRCSI FRCS (Urol)

Consultant Urological Surgeon
Department of Urology
Kings College Hospital
London, UK

George D Webster MB FRCS

Duke University
Durham, NC, USA

Roger Willén MD PhD

Department of Pathology
University Hospital
Lund, Sweden

E James Wright MD
John Hopkins Bayview Medical Center
Baltimore, MD, USA

Björn Wullt MD PhD FEBU

Consultant Urologist
Department of Urology
Lund University Hospital
Lund, Sweden
 Pagexiii

Foreword
Thistextisremarkableforthecomprehensivenessofthesubjectmatter,fortheknownexpertiseoftheauthorsandforthequa
thirdbookonthissubjectthatIhavebeenapartofoverthepastyears 51 anditperfectlycapturesthedevelopingscienceofuri
havelearnedfromourclinicalexperiences.Surgerywillcontinuetoevolvebecauseofoutcomesresearchand,becauseofthebludge
scienceofmedicine,thistextistimelyinthat
‘ state
itpresents
ofthe
’ inart
the
the
field.
Thehistoryofurinarydiversionisthatprocedureswereoriginallydevelopedtodealwithcongenitalabnormalitiessuchase
proceduresbecamepopulartotreatneurogenicbladder,particularlyinthespinaldysraphicchild,butnowtheyareprimarilyus
withpelvicmalignancyrequiringbladderremoval.Somuchofwhatwedotodayhasitsbasisinthevisionsofpriorsurgeons,andwhatis
bethefodderoffuturescholars
Tenchaptersarededicatedtothephysiologyandpathophysiologyoftheuseofintestinalsegmentsinurinarydiversionandthe
pertinentconcernsarediscussed,andinparticularthemanyconsequences
‘ foreign’ absorptive
ofhaving
surface
a incontactwithurine.
Theeditorsthenappealtothesurgeonwithinallusbypresentingseparatesections,eachrepletewithchapters,onthevar
orthotopicbladderstotheurethra,continentreservoirswithcatheterizableabdominalstomasand,becausehistoryhas
techniquesdivertingtheurinetoreservoirsusingtheanusforcontinence.Thesesurgicalsectionsarecompleteandcurrent
understandingoftherationaleandoutcomesforeach.
Therearemanysurgicalvariationsandpersonalpreferenceswithrespecttohowtoconstructacontinencemechanismandwh
Thesesubjectsareelaboratedbyexpertsinthefield.Nottobeforgotten,becauseitisstillthemostcommonlyperformeddiver
currentconceptsontheappliancedependenturostomyareappropriatelydiscussed,Furthermore,recognizingthemovetolessi
laparoscopicproceduresispresented.
Nostoneisleftunturnedinthiscompletetreatiseonurinarydiversionandthereaderisassuredofexcellentpracticala
GeorgeDWebsterMBFRCS
 Pagexiv

Acknowledgements
Theeditorsappreciatethesupportandenthusiasmoftheirassistants,LisaSt.ClairandKristinaGreiner,aswellasAlanBurge
productioneditor,bothofTaylorFrancis,
& inthepreparationofthisbook.Withouttheirefforts,thistextcouldnothavebeencom
responsibleforthetimelinessofitscompletionbyongoingcontactwiththecontributors,thepreparationoftheeditedmanus
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