V2-07: CONTINENT RIGHT COLON RESERVOIR USING CUTANEOUS APPENDICOSTOMY
VideoIntroductions and Objectives
There are a subset of patients who are not appropriate candidates for orthotopic neobladder (ONB) and still want to have a continent urinary reservoir. We present our technique of continent cutaneous right colon pouch using a catheterizable submucosally embedded appendicostomy.
Of 1964 patients diagnosed with bladder cancer undergoing radical cystectomy at our institution, 97 patients underwent continent right colon reservoir urinary diversion. Contraindications for ONB were non-functional and/or tumor involvement of urethra or bladder neck, history of pelvic radiation, and small bowel pathology with extensive involvement of the ileum.
We demonstrate our technique for continent right colon reservoir using the appendix as an efferent catheterizable continence mechanism. The ascending and proximal trasverse colon are detubularized and folded to form the reservoir component of the urinary diversion. (Figure 1) The ureters are anastomosed to the terminal ileum which acts as the afferent limb with the intact native ileocecal value providing the anti-reflux mechanism. The appendix is then tunneled submucosally with preservation of the mesentery in a flap-value technique to act as the continent catheterizable mechanism. (Figure 2)
A continent cutaneous right colon reservoir, with the terminal ileum receiving the ureters, and the use of the appendix as the continent catheterizable ostomy is a reasonable alternative for cutaneous urinary diversion when an intact appendix is present.