Conversion of a sigma rectum pouch to a continent cutaneous urinary diversion – enhancing quality of life through a bowel-sparing surgical approach

Purpose The sigmoid rectum pouch (SRP) is a continent anal urinary diversion that may cause long-term complications requiring revision. This study describes our bowel-sparing surgical (BSS) technique for conversion to a continent cutaneous urinary diversion (CCUD) and evaluates functional outcomes and quality of life (QOL). Methods We retrospectively analysed all patients undergoing SRP-to-CCUD conversion at our tertiary referral center between 2015 and 2020. Clinical records and follow-up data were reviewed. Endpoints included serum creatinine, urinary tract infections, pouch capacity, urinary continence (International Consultation on Incontinence Questionnaire [ICIQ]), fecal continence (Wexner score), and QOL (EuroQol-5D-5 L). Descriptive statistics were applied. Results Seven patients underwent conversion at a mean age of 32 years with a mean follow-up of 91 months. All procedures were successfully completed using a BSS approach preserving bowel length. No severe postoperative complications (≥ CDC 3) occurred. Renal function remained stable (mean preoperative serum creatinine 0.92 vs. 1.00 mg/dL postoperatively). Severe urinary tract infections decreased postoperatively. One-third of patients achieved full urinary continence, one-third mild, and one-third moderate incontinence. Fecal continence remained stable (four patients with perfect, three with good continence). QOL was favorable (mean EQ-5D-5 L index 0.93; mean VAS 76), with all patients reporting subjective improvement. Conclusion BSS conversion of SRP to CCUD is a feasible option in selected patients, preserving bowel length while maintaining renal function, acceptable continence, and good QOL.