Chronic constipation has been successfully treated with specific medications and bio-feedback therapy. Surgical manipulation for this condition can be an option when non-surgical interventions fail. We report here on a patient who was diagnosed as having intractable chronic constipation with hypoganglionosis. The patient was a 60 year-old male with the history of seizure and diabetes. This patient did not gain any clinical benefits from non-surgical regimens. Therefore, we performed a laparoscopically assisted total colectomy with J-pouch ileorectal anastomosis on this patient. The patient recovered from the surgery without complications and he had normal bowel functions. The postoperative anatomical pathology revealed a hypogaglionosis. In conclusion, a laparoscopically assisted total colectomy for a patient with intractable chronic constipation with hypoganglionosis is a good option and it may be a curative method.
Colectomy ; Colonic Pouches ; Constipation ; Humans ; Male ; Seizures

Rigid ureteroscopy is now established technique for the management of ureteral stones. We evaluated the experiences of rigid ureteroscopy retrospectively at our institutions from October 1990 to June 1991, 30 ureteroscopies were performed for the removal of ureteral stones and one ureteroscopy for the removal of Kock pouch stones. In 23 cases(74.2%), the stones were removed successfully. The likelihood of failure was greater for stones larger than 10mm and above the lower ureter. Among the reasons for failure to remove stones. the failure to insert the ureteroscope into the ureteral orifice was the most common. Complications were developed in 11 cases but managed conservatively in all cases. We agree that ureteroscopic removal of stone is the treatment of choice for lower ureteral stone of smaller than 10mm in size with proven efficacy and safety.
Colonic Pouches ; Retrospective Studies ; Ureter ; Ureteroscopes ; Ureteroscopy

The socially acceptable control of urine is the critical problem to the patient to be diversed of his urinary stream. From the first description of a urinary diversion by Simon in 1852, various methods for urinary diversion were described and modified. But, incontinence and application of a collecting device made the patients and surgeons disappointing, so that the hope for a safe, clean, comfortable and continent urinary diversion has been increasing in the field of urology. From the 1985, we experienced Kock continent ileal reservoir in 7 patients and ureterosigmoidostomy in 4 patients (total: 11 patients), who had all invasive bladder carcinoma.
Colonic Pouches ; Hope ; Humans ; Rivers ; Urinary Bladder ; Urinary Diversion* ; Urology

No abstract available.
Colonic Pouches* ; Cystectomy* ; Urinary Bladder Neoplasms* ; Urinary Bladder*

124 cases of urinary diversion were reviewed from September, 1974 to March. 1990. Studies were underwent mainly concerning the indications and the postoperative complications in several diversion procedures such as ileal conduit. ileocecal conduit, tubeless cutaneous ureterostomy. Kock pouch and Indiana pouch. Although ileal conduit and ileocecal conduit are one of reliable method with broad applications, the early and late complications are often troublesome. Also continent diversion such as Kock pouch and Indiana pouch need the long operative time with technical difficulties. Tubeless cutaneous ureterostomy have high incidence of stomal stenosis especially in normal sized ureter. Because there are no ideal urinary diversion today, the careful and thorough evaluation and consideration should be given in selecting appropriate urinary diversion method in each different cases.
Colonic Pouches ; Constriction, Pathologic ; Incidence ; Indiana ; Operative Time ; Postoperative Complications* ; Ureter ; Ureterostomy ; Urinary Diversion*

During follow-up of Kock pouch, we found 5 cases of stones in the pouches (3 cases in male and 2 cases in female). Follow-up period was ranged from 34 to 62 months. The size of the stones varied from 0.5 to 4.3cm. 4 cases of stones were managed by endourological procedures, using ultrasonic and electrohydraulic lithotripsy. A case fail to manage by endourological procedure end so needs open operation. No complication occurred during or after the procedure. Spinal anesthesias were necessary in 5 patients. The stones were usually developed around suture materials near efferent nipple valve. The major component of the stones was struvite. We suggest that causes of stone development in Kock pouch may be suture materials and infected residual urine.
Anesthesia, Spinal ; Colonic Pouches* ; Follow-Up Studies ; Humans ; Lithotripsy ; Male ; Nipples ; Sutures ; Ultrasonics

Urothelial tumors of the upper urinary tract are rare, serious diseases that are increasing in frequency. Because of similar embryologic and histologic, pathologic appearance, symptomatology of these tumors are considered as a single entity. We experienced 15 patients with urothelial tumors of the upper urinary tract, who were admitted to our Dept. of Urology during 8 years period from Jan. 1978 to Jan, 1986. The most common symptom was gross hematuria. The most common finding on excretory urogram was a non-visualization of the kidney. Treatment included nephroureterctomy with excision of bladder cuff, nephrectomy and partial ureterectomy, nephroureterectomy and total cystectomy with ileal conduit or Kock continent ileal reservoir. We report 15 cases of urothelial tumors with some review of literatures.
Colonic Pouches ; Cystectomy ; Hematuria ; Humans ; Kidney ; Nephrectomy ; Urinary Bladder ; Urinary Diversion ; Urinary Tract* ; Urology

PURPOSE: The aims of this investigation were to access the relative ratio of epithelial types within the anal canal after a double-stapled ileoanal reservoir (DSIAR) and to review physiologic and functional differences based on this diversity in epithelial types. METHODS: According to types of the epithelium present at histologic sections of the distally excised tissue ring ("donut") after the stapling for restorative proctocolectomy with construction of a DSIAR, one hundred thirty-eight patients with ulcerative colitis were stratified into two groups: 40 patients (22 males and 18 females) were categorized to be of lower anastomosis (group I), where squamous, squamous mixed with columnar, or squamocuboidal component was reported to be present, and 98 patients (50 males and 48 females) to be of higher one (group II), which was evidenced by columnar epithelium at the "donut". Physiologic and functional parameters were appraised between 2 groups to define whether this difference in epithelial types is associated with a significant difference in postoperative anorectal functional outcome. RESULTS: None of preoperative parameters reflecting resting and squeeze pressures showed significant differences between 2 groups. Postoperative mean and maximal resting pressures (MRP and MxRP) were declined to 48.8 16.9 mmHg and 67.1 21.3 mmHg in group I, and 61.1 22.7 mmHg and 90.0 38.6 mmHg in group II, differences of which were significant (P=0.046 and 0.031, respectively). Neither postoperative mean nor maximal squeeze pressure was, however, statistically different between 2 groups. Mean length of the high pressure zone was decreased in both groups postoperatively, but there were no intergroup differences. Rectoanal inhibitory reflex decreased significantly from 97.4% to 50% in group I and from 86.5% to 53.9% in group II, respectively (P<0.0001 in both). However, there was no significant intergroup difference postoperatively. Maximal tolerance volume and compliance of the reservoir were significantly improved postoperatively in both groups; from 52.2 26.1 ml and 2.8 3.3 to 163.3 115.7 ml and 14.7 15.3 in group I (P=0.0001, and <.0001, respectively), and from 77.0 59.5 ml and 4.4 6.8 to 167.3 87.9 ml and 28.7 44.0 in group II (P<0.0001, both). But there was no intergroup difference in either parameters postoperatively. There were no significant differences between groups relative to functional outcome except the diurnal incontinence to solid stool (P<0.011). CONCLUSIONS: Although epithelial types were shown to be variable at the anal side of the anastomosis after a DSIAR, these differences were not associated with physiologic and functional differences. Therefore, if technically feasible, this procedure can be performed with safety without fear of significant functional derangement.
Anal Canal* ; Colitis, Ulcerative ; Colonic Pouches* ; Compliance ; Epithelium ; Humans ; Male ; Proctocolectomy, Restorative ; Reflex

PURPOSE: To evaluate the effectiveness of a P-pouch configuration with a reservoir and recycled segment in restorative proctocolectomy. METHODS: There were 11 patients who underwent the P-pouch procedure. They were compared with healthy eight-control subjects. The P-pouch configuration was constructed using one firing of a 10 cm GIA stapler to form a 12-cm reservoir. Following that, the distal ileum (15+/-0.5 cm) was anastomosed to the proximal portion of the pouch. Pouch function was studied 23.3+/-4.4 months after ileostomy closure. We measured the frequency and amount of stool. The postprandial plasma peptide YY (PYY) response and the scintigraphic studies using 99m-Tc sulfur colloid were used to study transit. RESULTS: In the patient group, daily stool frequency and volume were 5.2+/-0.3 and 423.5+/-23.7 g, respectively. Stool seepage and pouchitis occurred in 45.5 % and 9.1%. In contrast to other pouch procedures, the postprandial increment of plasma PYY was similar the P-pouch patients and healthy controls (P>0.05). The integrated increment of plasma PYY for 180 minutes following meals was also not decreased in 9-pouch patient group compared with the healthy controls (1,050.0+/-127.8 pmol/l vs. 1146.0+/-150.0 pmol/l, P>0.05). Small intestinal transit time for healthy controls and the patient group averaged 89+/-21 and 117+/-12 minutes (P>0.05). The capacity of the ileal pouch was 372+/-22 ml, and the efficiency of ileal reservoir evacuation was 76 %. CONCLUSIONS: The P-pouch is a new and improved simple modification of the well-established J-pouch procedure, constructed using a single firing of a GIA stapler.
Colloids ; Colonic Pouches* ; Fires ; Humans ; Ileostomy ; Ileum ; Meals ; Peptide YY ; Plasma ; Pouchitis ; Proctocolectomy, Restorative* ; Sulfur

Urinary diversion with a continent ileal reservoir has been performed in 2 patients following the method modified by Skinner. An important modification included isolation of a narrow strip mesentery for 6-8cm along the efferent and afferent limbs of the pouch to allow adequate ileal intussusception and fixation to prevent reflux and to ensure continence. The reservoir generally is emptied by intermittent catheterization every 4 to 6 hours during the day and once at night. The volume capacity of the reservoir is more than 590ml. Retrograde reservoirgrams have demonstrated no reflux in one patient and mild reflux in the other patient and post-operative excretory urograms show normal urinary tract in one patient and mild hydronephrosis in the other patient. All patients are satisfied with this type of urinary diversion.
Catheterization ; Catheters ; Colonic Pouches* ; Cystectomy ; Extremities ; Humans ; Hydronephrosis ; Intussusception ; Mesentery ; Urinary Diversion ; Urinary Tract