Rajasekaran, S (2008) Uses of Intestines in Urology - Our institute experience. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: Bowel is frequently used in reconstructive urology for bladder augmentation, bladder replacement , as ureteral substitutes. Less commonly intestines may be used as urethral or vaginal substitutes(1). Our institute is a 25 years old urological service institute having vast experience in all open surgeries, endo urology and laparoscopic procedures having two units with experienced teachers. We frequently encounter lot of patients with genito urinary tuberculosis and carcinoma bladder. Many of the patients with extrophy epispadias complex patients presenting late are also managed effectively. I study through my dissertation work how we select, plan, and use intestines to augment, replace, substitute bladder and the early complications we faced. Comparing small intestine and large intestines also studied. AIMS OF THE STUDY: 1. To analyse various procedures done using intestines, 2. To analyse immediate and early complications, 3. To compare the various types of intestinal complications, 4. To compare the results, 5. To analyse the problems that can be rectified. MATERIALS AND METHODS: The study period is between September 2005 to April 2008. The study design is Prospective study analyzing the intestinal uses and early complications in our department of Urology, GRH and KMCH. Total number of patients included in this study are 21. Among twenty one patients : sex distribution Male patients : 15 Female patients : 6. Male patients predominant in my study with history of smoking, occupation risks such as painting , agriculturists with pesticides direct contact, history of tuberculosis. Patients with Genito Urinary TB requiring augmentation cystoplasty suffering from thimble bladder. Patients with muscle invasive ca bladder undergoing Radical cystectomy Patients with exstrophy of bladder, late presentation Disease pattern: 1. GU TB = 8, 2. Ca Bladder= 10, 3. Exstrophy of Bladder=2, 4. Ileal replacement =1. Procedures for diseases patients had undergone 1.Augmentation cystoplasty using ileum, right colon, sigmoid colon 2. Radical cystectomy with ileal conduit 3. Ileal substitution in multiple ureteric stricture 4. Ileal pouch in exstrophy of bladder, late presentation. In my study small intestines were used in 15 patients. Large intestines were used in 6 patients. Ileum alone was used in 15 patients, ileo caecum 2 patients, right colon alone in one patient, and sigmoid colon. in 3 patients. RESULTS AND DISCUSSION: In my two and half years study, I analysed various procedures done by us after proper evaluation of patients. Comparing urologists all over our country, we also prefer ileum as a most suitable segment for bladder substitution and augmentation. Even in majority of conduits we prefer ileum. The compliance, accomodation and decreased contractility makes ileum the best. When it is unavailable or the utility is not possible, other segments are used. CONCLUSION: Intestines are used in many forms as conduits, pouches, augmentation and orthotopic diversion Meticulous care in anastomosis is the must. Uretero enteric, intestine to intestine, intestine to thimble bladder. Early complications are avoided by preventive measures,peroperative techniques and postoperative care. Urologist has to acquire the skills of surgical gastroenterologist and vascular surgeon. Many patients may need CIC. My study shows 25%. Physiologically and urodynamically, Ileum is superior than colon. No substitute is better, God’s gift Natural urinary bladder can not be conquered by surgeon”s bladder( atleast till date ). Still viable option in many GU TB , ca bladder patients. Tissue engineering and genetics may take over.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Intestines ; institute experience. |
| Subjects: | MEDICAL > Urology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:09 |
| Last Modified: | 12 Oct 2017 01:09 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3436 |
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