Clinical and Urodynamic Features of a New Intestinal Urinary Sphincter for Continent Urinary Diversion

Koff, Stephen A.; Cirulli, Christopher; Wise, Henry

doi:10.1016/s0022-5347(17)38735-9

Cited by 17 publications

(6 citation statements)

References 6 publications

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“…These modifications include the use of surgical staples to fix the nipple to the wall of the reservoir [23], placement of Marlex or polyglycolic mesh collars around the intestine at the edge of the reservoir [23], imbrication or tapering of the ileal catheter conduit [3,20], submucosal implantation of the appendix as a catheter conduit [4], mechanical sphincters [5,6], and the use of an added segment in continuity with the reservoir lumen that is wrapped around the ileal catheter conduit to create an autologous sphincter (ease of construction mentioned by the authors) [13].…”

Section: Discussionmentioning

confidence: 99%

“…Although the Marlex collar improved continence, it also represented a foreign body, acting as a nidus for infection, and occasionally it eroded into the intestinal lumen. More recently, the use of absorbable mesh materials (Dexon) has decreased the risk of infection [13]. Additional maneuvers to secure the nipple valve enlisted the use of mechanical staples to fix the intussusceptum to the intussuscipiens, with three lines of staples (TA-55) being applied in the linear axis of the nipple valve.…”

Section: Discussionmentioning

confidence: 99%

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Continent small-intestine reservoir construction: a tapered intussusceptum promotes sustained continence

et al. 1996

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Developed for the study of dialysis in the continent jejunal reservoir (CJR), a novel, uncomplicated approach to achieve continence in construction of a small-bowel reservoir is presented. We utilize a technique of constructing a continent nipple valve, which entails the reduction or tapering of the intussusceptum prior to invagination into the reservoir. We have thus far performed the procedure successfully in 21 dogs. All animals have achieved absolute continence. Complications have occurred in two animals, neither complication involving the nipple valve. Pressure-volume cytometry in nine animals demonstrates continence in the awake animal at pressures of up to 40 cm H2O (volumes being limited by animal discomfort due to reservoir distention). In postmortem studies, reservoir capacities of > 1000 ml and pressures of > 70 cm H2O have been attained without loss of continence or prolapse of the nipple valve. Continence is sustained even when the reservoir and nipple valve are subjected to high intraluminal pressures. Incorporating a tapered intussusceptum, the continent reservoir provides absolute continence without the use of cumbersome mesh fixation or lithotropic intraluminal staples.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Continent small-intestine reservoir construction: a tapered intussusceptum promotes sustained continence

et al. 1996

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“…In this extremely surgically demanding and complicated technique, the increasing pressure inside the reservoir is transmitted via a separate tubular system on the actual efferent segment to create a ‘sphincter zone’. Continence is maintained only up to a certain pressure until leakage occurs, and UI is frequent [10–12].…”

Section: General Biophysical Propertiesmentioning

confidence: 99%

“…Continence is maintained only up to a certain pressure until leakage occurs, and UI is frequent [10][11][12].…”

Section: General Biophysical Propertiesmentioning

confidence: 99%

The efferent segment in continent cutaneous urinary diversion: a comprehensive review of the literature

Ardelt

Woodhouse

Riedmiller³

et al. 2011

BJU International

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Study Type – Prognosis (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? While the ileal conduit and orthotopic neobladder are the most commonly used diversions today, continent cutaneous reservoirs remain an invaluable treatment option for a well‐defined subset of indications. After several decades of surgical experience a continuous optimisation process, especially for the continence mechanism, is still ongoing. The continence mechanism largely determines the treatment success in terms of patient satisfaction and quality of life. At present, no consensus has been reached regarding an optimal technique. Common problems include stomal stenosis with impaired catheterisation, urinary incontinence, and nipple gliding. This review critically examines published reports on the various efferent segments used in continent catheterisable urinary reservoirs. It compares data regarding the complications as well as clinical performance. Hence, it provides a valuable comparison and insight into some of the biophysical properties, shortcomings and complications of the different outlets. Also, this view clearly demonstrates that literature evidence for each technique remains poor. OBJECTIVE • To critically assess the biophysical properties and current status of outlet formation in heterotopic intestinal urinary diversion. As despite three decades of clinical experience with continent cutaneous urinary diversion through bowel segments, no consensus has been reached for the optimal efferent segment although its function largely determines patient satisfaction. METHODS • A comprehensive Medline literature search using the Medical Subject Headings database (search terms: continent urinary diversion followed by either efferent segment, nipple, Mitrofanoff, Yang‐Monti, Benchekroun, tapered ileum, intussuscepted ileum, Kock pouch, T‐valve, or Ghonheim) was conducted to identify all full‐length original articles addressing the various principles and techniques of outlet formation as well as their outcomes and complications. • Examined series were published in English between 1966 and 2010. • All studies were systematically evaluated using a checklist (study design, number of patients, etc.) and rated according to the Oxford Centre for Evidence‐Based Medicine Levels of Evidence (LoE). RESULTS • While there was a continuous flow of publications over the last three decades, the vast majority of studies were retrospective case series with numerous confounding factors and poorly defined, non‐standardized outcomes (LoE, 3). Only a few investigations compare different efferent segments (LoE, 2a). • No randomized studies exist. • The major biophysical principles are based on the use of flap, nipple, and hydraulic valves. • Vermiform appendix, intussuscepted ileal nipple, and the Yang‐Monti tube are the most popular techniques and have well‐established data on outcomes, complications, and failure rates. • Artificial sphincter systems and tissue engineering have provided disappointing results thus far. M...

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“…Eine Vereinfachung ist der "Lundiana"-outlet [60], der jedoch hinsichtlich der Kontinenz letztlich wieder unzuverlässig zu sein scheint [61 ]. Weitere Modifikationen des "pressure equilibration principle" mit einer gerichteten Flüssigkeisumleitung zum Zwecke der Kompression eines Nippels "hydraulische Klappe") wurden von Koff [62] und Benchekroun [63] beschrieben, die jedoch sowohl kompliziert in der Konstruktion und/oder unzuverlässig hinsichtlich der Kontinenz sind [16].…”

Section: Problem Kontinenzunclassified

Komplikationen nach Zystektomie und Harnableitung: Was ist wichtig für die Indikationsstellung?

Roth¹

1998

Aktuel Urol

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Clinical and Urodynamic Features of a New Intestinal Urinary Sphincter for Continent Urinary Diversion

Cited by 17 publications

References 6 publications

Continent small-intestine reservoir construction: a tapered intussusceptum promotes sustained continence

Continent small-intestine reservoir construction: a tapered intussusceptum promotes sustained continence

The efferent segment in continent cutaneous urinary diversion: a comprehensive review of the literature

Komplikationen nach Zystektomie und Harnableitung: Was ist wichtig für die Indikationsstellung?

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