Complications of the Afferent Antireflux Valve Mechanism in the Kock Ileal Reservoir

Stein, John P.; Freeman, John A.; Esrig, David; Elmajian, Donald A.; Tarter, Tom H.; Skinner, Eila C.; Boyd, Stuart D.; Huffman, Jeffry L.; Lieskovsky, Gary; Skinner, Donald G.

doi:10.1016/s0022-5347(01)66131-7

Cited by 90 publications

(39 citation statements)

References 28 publications

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“…However, patients with a Kock pouch were significantly more likely to require surgical revision for three main complications, i.e. stenosis, calculi and prolapse of the ileal nipple [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Ileal T‐pouch as a urinary continent cutaneous diversion: clinical and urodynamic evaluation

Marino¹,

Laudi²

2002

BJU International

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Objective To report the functional results of continent cutaneous urinary diversion with ileum, using the serous-lined extramural valve and Mitrofanoff procedure for the continence mechanism. Patients and methods From April 1999 to October 2001, 18 patients (mean age 68 years) underwent radical cystectomy for invasive bladder cancer involving the bladder neck, urethra or prostate; they then had an ileal continent cutaneous T pouch constructed. The mean (range) follow-up was 12 (4-20) months. The first five patients had reconstructions using the original orthotopic T-pouch configuration, but in subsequent patients the technique was simplified, reducing the ileal segments. The ureteric-intestinal anastomosis was made using a split-cuff nipple technique.Results All patients were continent day and night, and there were no late complications. All cutaneous continent T pouches had a good capacity and low pressure, with no urinary reflux. No catheterization difficulties were reported and the evacuation intervals were <4 h. Conclusions This ileal cutaneous continent diversion is a versatile technique; the T-valve can be used successfully as a continent mechanism, ensuring continence day and night. The simplified technique maintains a reservoir of good capacity and compliance, thus preserving <13 cm of ileal tract. The ureteric intestinal anastomosis by the split-cuff nipple technique is suitable in undilated and peristaltic ureters.

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Section: Introductionmentioning

confidence: 99%

Ileal T‐pouch as a urinary continent cutaneous diversion: clinical and urodynamic evaluation

Marino¹,

Laudi²

2002

BJU International

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“…However, this superiority should not be achieved by increasing the risk of upper urinary tract deterioration. Stein et al [10] reported that a low pressure reservoir should be applied with any type of continent uri-Okuno/Coronel/Yanagawa/Takeda/ Kawamura nary diversion in order to maintain upper urinary tract functions. A number of reports have been published concerning reservoir capacity and pressure with regard to the configuration of the upper urinary tract on IVP.…”

Section: Discussionmentioning

confidence: 99%

Effect of Increased Intrareservoir Pressure on Upper Urinary Tract Function in Continent Urinary Diversion PatientsAssessed by Radioisotope Renography

Okuno¹,

Coronel²,

Yanagawa³

et al. 2000

Urol Int

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To assess upper urinary tract function and determine an ideal continent reservoir capacity, we investigated the relationship between intrareservoir pressure and functional parameters using radioisotope renography. Forty-three patients for whom ileal reservoir construction was performed by Kock pouch (n = 33) or Hautmann’s ileal neobladder (n = 14) approaches between November 1984 and September 1996 were studied. After the reservoir contents were catheterized, ^99mTc-MAG 3 renoscintigraphy was carried out and time activity curves in the kidney (renogram) and reservoir (reservoirgram) were recorded, while saline solution was poured into the reservoir for monitoring of intrareservoir pressure. Three basic abnormal curves were noted in the excretory phase on renograms: a normal downward curve followed by an upward curve, a continuous upward curve associated with or without a sharp decline after the catheterization of the reservoir contents, and episodes of spike waves. Based on these curves, renograms were classified into five types: normal, high pressure, retention, obstruction, and reflux. Abnormal types were noted with 51 of 65 renal units (78.5%) in the Kock pouch group and 15 of 25 renal units (60.0%) in the neobladder group. This examination method may be useful for evaluating urodynamics in the upper urinary tract of patients with a continent ileal reservoir and provide data on adequate voiding volumes for the individual patient.

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“…However, this risk appears, to be appreciatively higher after an antireflux technique than after direct anastomosis, irrespective of the anastomosis technique and the segment of bowel used 11,24,25 with a reported stricture rate of 1-4% for the direct anastomosis and of 9.5-20% for the different antireflux techniques described in M A N U S C R I P T…”

Section: Anastomotic Stricture: Refluxing Vs Nonrefluxing Techniquesmentioning

confidence: 99%

“…Dilatation of the upper urinary tract is the major concern in ureteroileal anastomosis 11 and can be caused by strictures of the ureter and reflux 7 .…”

Section: Introductionmentioning

confidence: 99%

Effects on renal function of obstructive and nonobstructive dilatation of the upper urinary tract in ileal neobladders with refluxing ureteroenteric anastomoses

Minervini

Pagni²,

Mariani³

et al. 2010

European Journal of Surgical Oncology (EJSO)

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. M A N U S C R I P T A C C E P T E D ARTICLE IN PRESS M A N U S C R I P T A C C E P T E D ARTICLE IN PRESSAims. To investigate the incidence and long term effects on kidney function of obstructive and nonobstructive dilatation of the upper urinary tract in patients with ileal neobladder with refluxing ureterointestinal anastomoses.Methods We retrospectively analyzed a prospectively derived database of 110 patients with bladder cancer and who were treated with an ileal neobladder between 1996 and 2007 using refluxing endto-side ureterointestinal anastomoses on a short afferent limb. The mean follow up was 65 months.At every follow up visit the patients had an analysis of serum creatinine, urine culture, abdominal CT or ultrasonography, and, if there was dilatation of the upper urinary tract, 99mTc-DTPA renal scintigraphy was requested.Results. In all, 206 renoureteral units were included in the study. Overall, seven had anastomotic stricture and of those, three were symptomatic and were corrected; while four were asymptomatic and of those, only two, with preserved split GFR, were surgically treated, while the remaining two, with a poor split GFR, were followed up. The last 99mTc-DTPA showed a preserved split GFR in the reimplanted units and further split renal function decrease in untreated units. Nonobstructive dilatation of the upper urinary tract, caused by reflux, was diagnosed in 13 units. The dilatation was bilateral in three patients with recurrent UTIs and urosepsis, and the split GFR was bilaterally reduced at diagnosis with a further reduction at the last 99mTc-DTPA. The remaining seven units with sterile urine, showed a preserved split GFR during follow up.Conclusions. All strictures, regardless of their severity, should be immediately corrected. Reflux per se does not provoke renal impairment unless recurrent UTIs and urosepsis are present.

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Complications of the Afferent Antireflux Valve Mechanism in the Kock Ileal Reservoir

Cited by 90 publications

References 28 publications

Ileal T‐pouch as a urinary continent cutaneous diversion: clinical and urodynamic evaluation

Ileal T‐pouch as a urinary continent cutaneous diversion: clinical and urodynamic evaluation

Effect of Increased Intrareservoir Pressure on Upper Urinary Tract Function in Continent Urinary Diversion PatientsAssessed by Radioisotope Renography

Effects on renal function of obstructive and nonobstructive dilatation of the upper urinary tract in ileal neobladders with refluxing ureteroenteric anastomoses

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