An approach to stoma-less continent urinary diversion by uretero-ileoceco-proctostomy (ileocecorectal bladder)]

The current practice of continent urinary diversion still places the patients under the restraint of the stoma and intermittent catheterization. To overcome these problems, we developed a new technique of urinary diversion of which continent is controlled by the anal sphincter. The isolated ileocecal segment is intussuscepted and interposed between the ureters and the rectum. The conjoined ureters are anastomosed to the stump of the ileal limb, and the antimesenteric portion of the cecal limb is joined to the anterior wall of the rectum. The surgical procedure is simpler than that of the continent reservoirs currently employed. The intussuscepted ileocecal segment prevents fecal reflux to the upper urinary tract and may also inhibit carcinogenesis at the uretero-intestinal junction. Additionally, the rectal capacity is augmented by the side to side anastomosis between the cecal limb and the rectum. Our preliminary experience in 10 cases were satisfactory with respect to voiding function, antireflux mechanism of the intussuscepted ileocecal segment and quality of life. The results will justify further trials with this stomaless continent urinary diversion for those in whom the urethra cannot be used.