Continent Ileal Pouch Using the Serous&amp;ndash;Lined Principle

Kato, Hiroyuki; Igawa, Yasuhiko; Kiyokawa, Hideo; Iwata, Koichi; Nishizawa, Osamu

doi:10.1159/000020260

Cited by 5 publications

(9 citation statements)

References 8 publications

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“…The antirefluxing mechanism provided a unidirectional flow and the continent mechanism functioned effectively in a similar way to the flap‐valve principle [4,6]. Recently, we reported a modification of their technique for creating a continent ileal pouch, whereby we preferred to make the continent valve in the anterior pouch wall [7]. Herein, we report an evaluation of all patients, including those reported previously, treated at our institution and in whom the serous‐lined principle was adopted for urinary reconstruction.…”

Section: Introductionmentioning

confidence: 99%

The serous‐lined tunnel principle for urinary reconstruction: a more rational method

et al. 2001

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Objective To examine the feasibility of using the serouslined-tunnel principle for orthotopic neobladder, continent cutaneous diversion and ureteric replacement by an intestinal segment. Patients and methods We created: (i) an orthotopic ileal neobladder using the serous-lined technique for antire¯uxing ureteric implantation in 16 patients; (ii) a continent ileal pouch, adopting the principle for continent-valve construction and for ureteric implantation, in 10 patients (another patient with a failed continent valve underwent revision using an adaptation of this principle; and (iii) by applying the same principle an ileal ureter with a proximal antire¯uxing mechanism was constructed in two patients (with lower ureteric cancer), and total replacement of the ureter by a tubular segment of the colon in association with a continent transverse colon pouch in one irradiated patient.Results In all, 52 ureters implanted into ileal neobladders or continent pouches functioned well, with neither obstruction nor re¯ux; 11 continent valves functioned well with no incontinence. Two patients with ileal ureters showed no ileo-ureteric re¯ux and had less hydronephrosis than before surgery. The tubularized ureter provided a unidirectional¯ow into the pouch. Conclusion Ureteric reimplantation and continent valve formation achieved by adopting the serous-lined tunnel principle provided satisfactory results. The versatility of the principle is apparent in the present experience and the creative application of the serouslined tunnel principle should be possible in urinary reconstruction.

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Section: Introductionmentioning

confidence: 99%

The serous‐lined tunnel principle for urinary reconstruction: a more rational method

et al. 2001

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“…This fact may be a main reason for the long operation time and the number of postoperative complications, although statistically only a trend was demonstrable. Other reports about sophisticated urinary diversion did not even mention the operation time or complication rates [13] . In addition, the learning curves of the 3 surgeons in the present study may have contributed to the long operation time.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Functional Results after Continent Cutaneous Urinary Diversion with the Ileal Double-T-Pouch

Seifert

Obaje²,

Müller-Mattheis³

et al. 2008

Urol Int

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Introduction: The aim of the study was to assess the clinical and functional results after continent cutaneous diversion with the ileal double-T-pouch. Patients and Methods: Between July 1998 and July 2006, 19 patients underwent continent urinary diversion with a cutaneous ileal double-T-pouch. Follow-up investigations included blood chemistry, renal ultrasound and evaluation of the outlet function. The median follow-up was 24 months (range 3–76). Results: There were no intraoperative complications and no perioperative mortality. Early postoperative complications not related to urinary diversion occurred in 6 patients (31.6%). Five patients developed complications related to the urinary diversion (26.3%). The mean operating time was 580 min (420–840). Including the patients who had good results after reoperation, 16 out of the 19 patients (84.2%) were continent day and night without any catheterization difficulties. The average pouch capacity was 490 ml (range 250–1,100). A mild acidosis was the only metabolic disorder observed. During follow-up renal function remained stable in all patients, urinary reflux, recurrent pyelonephritis or stone formation were not found. Three patients with a body mass index >30 developed a necrosis of the efferent loop resulting in pouch cutaneous fistulas. Conclusions: Continent cutaneous urinary diversion with the ileal double-T-pouch led to good intermediate functional and clinical results. However, construction of the pouch is sophisticated, resulting in a long operation time. The double-T-pouch is not recommended in obese patients.

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“…We personally recognized this Yang-Monti method to be geometrically well designed and practically useful, since it could avoid problems inherent in the use of either the appendix or a tapered ileum [6].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the augmentation effect itself, the pouch or flap used for augmentation greatly narrows the gap to the umbilicus or suitable skin site, and provides sufficient support even if the tube is short, since the mesenteric pedicle to the tube and the tissue used for augmentation may be mobilized together. Furthermore, these effects are greatly enhanced when the Yang-Monti tube is applied using the same-pedicle concept, since the tube can be easily embedded in the pouch wall with no interference with the mesenteric pedicle [6]. To prevent dilatation of the Yang-Monti tube, our practice is to ensure that the transverse suture line of the tube is facing the anterior pouch wall (fig.…”

Section: Discussionmentioning

confidence: 99%

“…to the appendix because of the proximity of the former to the pouch and the adequate mobility of its vascular pedicle [6]. Having recognized the advantages of the use a reconfigured ileal tube connected to the same mesenteric pedicle as the pouch, we adapted the original idea aggressively to reconstructive surgery of the urinary tract, and we have now evaluated this modified procedure.…”

Section: Introductionmentioning

confidence: 99%

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The Same-Pedicle Concept for Continent Urinary Diversion Using a Yang-Monti Reconfigured Tube

Kato

Igawa²,

Nishizawa³

2004

Urol Int

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Objective: To facilitate the anastomosis of a continent valve to the umbilicus or a suitable skin area, we used a reconfigured tube made from the same segment of the intestinal reservoir as that used to construct the urinary pouch. Materials and Methods: Seven patients underwent continent ileal-pouch formation using a reconfigured ileal tube following cystectomy for bladder cancer. Two irradiated patients and 1 patient with neurogenic bladder underwent continent colon-pouch construction with a reconfigured colon tube. Results: The average length of the reconfigured ileal tube was 5 cm, while the colon tube was maximally 10 cm long. All procedures were technically straightforward. All the continent pouches functioned well, without catheterization difficulties. Conclusions: Since the Yang-Monti tube and the pouch are easily mobilized, being based on the same vascular pedicle, and can therefore bridge the gap, making the umbilical anastomosis was greatly facilitated. Sufficient support for the tube is provided by the pouch.

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Continent Ileal Pouch Using the Serous–Lined Principle

Cited by 5 publications

References 8 publications

The serous‐lined tunnel principle for urinary reconstruction: a more rational method

The serous‐lined tunnel principle for urinary reconstruction: a more rational method

Clinical and Functional Results after Continent Cutaneous Urinary Diversion with the Ileal Double-T-Pouch

The Same-Pedicle Concept for Continent Urinary Diversion Using a Yang-Monti Reconfigured Tube

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