Evolution of the Rectal Bladder as a Method for Urinary Diversion

Abstract

A critical analysis of previous reports reveals 2 disorders of the rectal bladder: recurrent pyelonephritis with subsequent loss of renal function (30%) and nocturnal urinary leakage (40%). In a randomized prospective study, the role of a submucosal tunnel for prevention of reflux was evaluated. This technique could provide a patient unidirectional flow of urine in the majority of cases (82.5%). Urodynamic measurements (including flowmetry, rectal pressure and anal electromyography activities) indicated that the driving force for voiding is the voluntary increase of the intra-abdominal pressure rather than the intrinsic contractions of the smooth muscles of the rectum. Attempts at control of nocturnal urinary leakage were directed towards increasing the resistance offered by the pelvic floor. The efficiency of imipramine hydrochloride to achieve this goal was tested against a placebo in a clinical trial performed in a prospective randomized fashion. This treatment was effective in the control of enuresis in a significant number of patients (75%). Apparently the rectal bladder with a terminal colostomy is a highly recommended method for permanent urinary diversion when these 2 modifications are used.