ABSTRACT
The notion of bladder emptying by means of intermittent catheterization has gained universal acceptance by both patients and physicians. This has led to an enormous expansion in the use of continent urinary reservoirs for patients without bladders. Leg bags and stomal appliances play only a small role in the surgical armamentarium of urinary diversion. Since 1950 when Gilchrist et al1 described a technique for construction of a continent urinary reservoir (CUR) many techniques have been described. The CUR has to fit certain criteria, hold large volumes at low pressures, prevent reflux, be continent and allow for complete emptying. Most of the described reservoirs such as the Indiana Pouch,2 the Kock Pouch,3 and the Mainz Pouch4 use varying lengths of ileum and/or cecum to meet these objectives. Neobladders have also been constructed from ileum and sigmoid colon. In 1989, Bihrle et al5 described a technique for creating continent reservoir using transverse colon with tubularized segment of stomach implanted beneath the tinea as a catheterizable stoma. Each bowel segment has its own advantages and disadvantages and certainly a surgeon must feel comfortable with the segment used. Many times, however, particularly in pediatric patients, the clinical situation dictates unique reservoir composition.
