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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/04/06 18:47:55」(JST)

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A ureterosigmoidostomy is a surgical procedure where the ureters which carry urine from the kidneys, are diverted into the sigmoid colon. It is done as a treatment for bladder cancer, where the urinary bladder had to be removed. Rarely, the cancer presents in children between the ages of 2 & 10 yrs old as an aggressive rhabdomyosarcoma, although there are diagnoses of children as young as 3 months old. The procedure was also used several decades ago as a correctional procedure for patients born with bladder exstrophy. In the case of some bladder exstrophy patients, occasional bowel incontinence (in this case, a mixture of urine and feces similar to diarrhea) at night is one uncontrollable consequence.

Another consequence of this procedure is an increased risk of kidney infections (nephritis) due to bacteria from faeces travelling back up the ureters (reflux). Patients are commonly put on oral prophylactic antibiotics to combat infections in the uretery tract and the kidneys but this can lead to tolerance of the antibiotic, so over time the patient can build up tolerance to a large number of oral antibiotics, leading to a need for IV (intravenous) antibiotics administered while the patient is an inpatient.

As well as this, the urine entering the colon can cause diarrhea and salt imbalance due to the sodium and chloride in the urine. Urea levels in the blood are higher due to urea crossing the colon wall. In the large intestine, sodium is swapped for potassium, and chloride for bicarbonate, this causes an acidosis and hypokalaemia. Many patients take sodium bicarbonate to combat this.

Patients with ureterosigmoidostomy have an increased chance of developing carcinoma of the colon after living with the modification for a number of years, on average 20–30 years after the operation, which can also lead to severe surgical adhesions.

This operation is no longer popular in many countries, with an ileal conduit (where the ureters lead into a loop of small intestine) being preferred. However, it is still popular in developing countries as the maintenance of an ileal conduit or a catheter is seen to be more difficult.

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1. 膀胱切除術後の尿路変更および尿路再建 urinary diversion and reconstruction following cystectomy
2. 尿路変更後の腎合併症 renal complications following ureteral diversion
3. 尿路上皮膀胱癌の初期アプローチおよびマネージメントの概要 overview of the initial approach and management of urothelial bladder cancer
4. 尿路上皮膀胱癌に対する根治的膀胱全摘除術および膀胱温存治療 radical cystectomy and bladder sparing treatments for urothelial bladder cancer
5. 婦人科癌に対する摘除術 exenteration for gynecologic cancer

English Journal

The Manchester-Fothergill and the Elevate Posterior® technique for the correction of a cervical elongation and large enterocele in a patient with bladder exstrophy and multiple surgeries.

Ferrer ML1, Sánchez EB, Hernández LH, Linde FM, Peñalver AI, Díaz AN.
International urogynecology journal.Int Urogynecol J.2015 Aug;26(8):1239-42. doi: 10.1007/s00192-014-2610-8. Epub 2015 Jan 13.
INTRODUCTION AND HYPOTHESIS: A 60-year-old woman presented with congenital bladder exstrophy, urinary incontinence since birth, and pelvic organ prolapse since the menopause at the age of 46 years.METHODS: The patient (gravida 2, para 2 by cesarean sections and tubal ligation) described an extensiv
PMID 25578871

Squamous cell carcinoma at bladder exstrophy site after early cystectomy.

Lane GI1, Kwaan M, Lewis J.
Pediatric surgery international.Pediatr Surg Int.2015 Jul 14. [Epub ahead of print]
Patients with bladder exstrophy-epispadias complex (BEEC) are at risk for bladder cancer, usually this presents as adenocarcinoma (Smeulders "BJU Int" 87:623-628, 2001). Squamous cell carcinoma (SCC) is rare, with only 13 documented case reports. This is a case of SCC in a 78-year-old man with BEEC
PMID 26169528

Laparoscopic anterior exenteration with intracorporeal uretero-sigmoidostomy.

Jamkar AV1, Puntambekar SP2, Kumar S2, Sharma V2, Joshi S2, Mitkare S2.
Journal of minimally invasive gynecology.J Minim Invasive Gynecol.2015 May-Jun;22(4):538-9. doi: 10.1016/j.jmig.2015.01.020. Epub 2015 Jan 24.
STUDY OBJECTIVE: To demonstrate the feasibility of laparoscopic anterior exenteration with intracorporeal ureterosigmoidostomy.DESIGN: After Institutional Review Board approval was obtained, patients who had undergone laparoscopic anterior exenteration with intracorporeal ureterosigmoidostomy were a
PMID 25623371

Japanese Journal

造設16年目のIndiana pouch内に偶発的に大腸腺癌が認められた1例

杉田佳子,石川弥,平井祥司 [他],丸典夫,杉田敦,西盛宏,藤田哲夫,吉田一成,岩村正嗣
泌尿器科紀要 = Acta urologica Japonica 59(8), 531-534, 2013-08
… Adenocarcinoma occurrence after ureterosigmoidostomy is well-known. …
NAID 120005322752

尿管S状結腸吻合術24年後に発症した吻合部腺癌の1例

片桐敏雄,岡本康介,小池淳一,大塚由一郎,田村晃,船橋公彦,金子弘真,寺本龍生,渋谷和俊,高橋敬二
日本外科系連合学会誌 32(2), 234-237, 2007-04-30
NAID 10020113520

尿管Ｓ状結腸吻合術２４年後に発症した吻合部腺癌の１例

片桐敏雄,岡本康介,小池淳一,大塚由一郎,田村晃,船橋公彦,金子弘真,寺本龍生,渋谷和俊,高橋敬二
日本外科系連合学会誌 32(2), 234-237, 2007
尿管S状結腸吻合術24年後に発症した吻合部腺癌の1例を経験した。症例は90歳, 男性, 24年前膀胱癌にて膀胱全摘出術および尿管S状結腸吻合術を施行された。血便を主訴に当院を受診した。大腸内視鏡検査を行ったところS状結腸の左尿管吻合部と右尿管吻合部付近にそれぞれ腫瘍を1カ所ずつ認めた。悪性腫瘍を疑い生検を行ったがそれぞれGroup 3, Group 4であった。大腸内視鏡の肉眼所見では癌の可能性も …
NAID 130004514633