The transverse colonic reservoir: the Unicamp technique

Abstract

Objective To present the results of a continent and nonre¯uxing transverse colonic urinary reservoir technique. Patients and methods Twenty patients who had received high doses of irradiation underwent construction of transverse colonic reservoir as a primary form of urinary diversion. Fourteen patients had a vesicovaginal ®stula after de®nitive radiation therapy for gynaecological tumours and six had radiation therapy for invasive bladder cancer as a de®nitive treatment. They were followed for a median (range) of 4.5 (1±8) years. Intravenous pyelography before diversion showed mild hydronephrosis in 10 patients. Results After diversion, hydronephrosis improved in four patients and no upper tract deteriorated. All but one of the pouchograms showed no ureteric re¯ux. All the patients required clean intermittent self-catheterization every 3±4 h. Persistent asymptomatic bacteriuria was present in 14 patients, although clinical urinary tract infections were not reported. A moderate metabolic acidosis was present in 12 patients, but none required treatment. The urodynamic evaluation revealed a median (range) reservoir capacity of 450 (350±600) mL, with no contractions or contractions of <35 cmH 2 O. Conclusion These results suggest that the Unicamp technique for constructing a transverse colonic reservoir is a safe and effective diversion, and is recommended as an alternative method for patients treated by pelvic irradiation.

Colon pouch (Mainz III) for continent urinary diversion

“…[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.…”

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

“…The use of irradiated segments may present an unnecessary risk of complications due to radiation therapy as well as the use of irradiated bladder [1][2][3]. Transverse colon is not located in the radiation field [4]. When the transverse colon is utilized, continence can be achieved by using a nipple valve, a tapered segment embedded in the pouch wall or an implanted conduit [4,5].…”

“…Transverse colon is not located in the radiation field [4]. When the transverse colon is utilized, continence can be achieved by using a nipple valve, a tapered segment embedded in the pouch wall or an implanted conduit [4,5]. The advantage of re-configuring transversally a short colon segment is the creation of a long tube (10 cm), allowing the construction of an effective continence mechanism (serous-line technique) and the use in patients with thick abdominal wall.…”

“…The risk of utilizing previously irradiated bowel segments is well known and should be avoided [1,2,3]. The use of transverse colon is a safe and effective alternative [4,5]. Heterotopic reservoirs demand an easily catheterizable conduit.…”

Pelvine Exenteration wegen gynäkologischer Tumoren

“…Um solche Elektrolytverschiebungen frühzeitig zu erkennen und ihnen vorbeugen zu können, sind insbesondere im frühen postoperativen Verlauf bei kontinenter Harnableitung, regelmäßige Kontrollen des Säure-Abb. 2 …”