Continent Urinary Diversion in Patients with Pelvic Irradiation: An Alternative Utilizing Transverse Colon Reservoir

Authors from Germany present data on the Mainz III pouch, where a colon segment is used. The results were very encouraging, with excellent continence rates. They suggest that this technique of continent urinary diversion should be considered as a suitable alternative to other methods. OBJECTIVE To evaluate the use of a continent cutaneous pouch made exclusively of colon (Mainz pouch III), as excellent results with the Mainz pouch III in irradiated patients suggested that the indication for this type of urinary diversion could be extended. PATIENTS AND METHODS The outcome of 24 patients with continent cutaneous urinary diversions using colon segments (Mainz pouch III) was investigated retrospectively. Overall, 22 of the patients had a malignant disease and two a benign disease; 16 had a hysterectomy and pelvic exenteration for gynaecological tumours; two men with a rhabdomyosarcoma of the prostate had a radical cystoprostatectomy; one woman had pelvic exenteration for bladder cancer; one man had a simultaneous rectum resection due to infiltrating rectal cancer, and another a left nephrectomy with cystectomy for concomitant kidney and bladder tumour. Benign indications were hyper‐reflexive bladder after polytrauma and two cases of neurogenic bladder dysfunction. Eighteen patients had radiotherapy (32–48 Gy) before the urinary diversion. RESULTS The mean (range) follow‐up was 35 (12–65) months. The mean pouch capacity was 293.8 mL. Three patients died during the follow‐up (two from disease progression and one suicide); 20 patients were fully continent, four with reduced pouch capacity (<300 mL) had slight incontinence and are wearing a protective pad (band‐aid at the umbilicus). All patients use intermittent self‐catheterization (mean catheterization frequency 6.8/day, range 6–12). Complications related to the pouch were one outlet stenosis that required revision. Postoperative pouchograms showed asymptomatic reflux in four patients. None of the patients developed metabolic acidosis or diarrhoea. CONCLUSIONS The Mainz pouch III is an alternative to other types of continent urinary diversion

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“…A similar technique was used by D’Ancona et al. [16] in a previously irradiated female patient. Stein et al.…”

Section: Discussionmentioning

confidence: 99%

“…[11], who reported a low complication rate with the Mainz III in irradiated patients. Reports on previously irradiated patients showed better results for the colon pouch and the flap valve as a continence mechanism than other techniques using irradiated bowel [7,10–12,16,25–27]. Stein et al.…”

Section: Discussionmentioning

confidence: 99%

Colon pouch (Mainz III) for continent urinary diversion

et al. 2007

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“…descendes als Kontinenzmechanismus, überholt. Die weiteren Publikationen zum TP kamen aus Japan [15], Brasilien [5] und Deutschland [16,31].…”

Section: Introductionunclassified

“…Bei einem medianen FU von 4,5 Jahren publizierten Fereira et al [5] Auf die Frage, ob die Patienten sich nochmals für die gleiche operative Prozedur (Harnableitung) entscheiden würden, antworteten 98% der verbliebenen Patienten mit einem "Ja" und würden diese auch weiterempfehlen. …”

Section: Introductionunclassified

Harnableitung und Dickdarm

Ahyai

Sayedahmed

Engel

et al. 2012

Urologe

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In the vast majority of cases the terminal ileum is used for incontinent or continent bladder substitution. However, in irradiated patients the use of ileum segments or the ileocecal reservoir is associated with an increased risk of early and late complications. For this reason these patients should be treated with a transverse conduit or pouch as the method of choice if urinary diversion is indicated. The superior outcome of this high urinary diversion is due to the use of non-irradiated segments of the colon and ureter. The lack of experience in large bowel surgery by today's urologists should be compensated by training or referral of these high risk patients to a specialized center.

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“…Ces lésions, parfois tardives, peuvent altérer les différentes voies du contrôle vésicosphinctérien en cas de radiothérapie pelvienne [1][2][3][4][5][6][7]. Toutes les structures nerveuses peuvent être touchées, qu'il s'agisse de lésion des centres réflexes médullaires, des voies de conduction périphériques ou encore des plexus [8][9][10][11].…”

Section: Introductionunclassified

Les complications neuropérinéales de la radiothérapie pelvienne

et al. 2010

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La radiothérapie pelvienne peut déterminer diverses complications neurologiques. La myélite radiothérapique est la plus fréquente, mais des plexopathies sacrées postradiques peuvent aussi survenir. Les troubles mictionnels sont caractérisés par un syndrome clinique d'hyperactivité vésicale avec pollakiurie, incontinence sur urgence et impé-riosité, secondaire à une hyperactivité du détrusor ou à un défaut de compliance. En cas d'atteinte neurogène purement périphérique, rétention urinaire et fuite sur défaillance sphinctérienne peuvent s'observer. Mots clés Radiothérapie · Myélopathie radique · Plexite sacrée · IncontinenceAbstract Pelvic irradiation can lead to various neurologic syndromes. Radiation myelopathy is the most common lesion, but acute and chronic lumbosacral plexopathy can occur several months or years after pelvic irradiation. Micturitional disturbances are characterized by overactive bladder syndrome with frequency, urgency, and urge incontinence. These symptoms are secondary to detrusor overactivity or compliance alteration during the filling phase. In case of neurogenic peripheral lesions, urinary retention and stress incontinence following lack of urethral sphincter pressures are observed.

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Continent Urinary Diversion in Patients with Pelvic Irradiation: An Alternative Utilizing Transverse Colon Reservoir

Cited by 4 publications

References 8 publications

Colon pouch (Mainz III) for continent urinary diversion

Colon pouch (Mainz III) for continent urinary diversion

Harnableitung und Dickdarm

Les complications neuropérinéales de la radiothérapie pelvienne

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