This paper presents a description of the technique, the indications, and the results of a new ileosigmoid substitute for the human bladder. Like most "new" operations, it is largely a combination of techniques separately described by other surgeons.
The fundamental principle of substituting a closed sleeve of sigmoid for the excised bladder was reported by McLean et al.,1 and to them I owe the basic plan for the modifications I have devised.
McLean excised the bladder above the prostate and seminal vesicles. Between severed ureters and prostate he interposed a sleeve of sigmoid which had been removed from bowel continuity by simple anterior resection, care being taken to preserve blood supply to the sleeve. He anastomosed the prostatic urethra to the side of the sigmoid sleeve and brought out the distal limb of the sleeve as a temporary colostomy. This colostomy was closed in a secondary operation. Although McLean's