Urinary Diversion Via a Continent Ileal Reservoir: Clinical Results in 12 Patients

Kock, N. G.; Nilson, A. E.; Nilsson, Leif; Norlén, Lars; Philipson, B. M.

doi:10.1016/s0022-5347(17)53001-3

Cited by 608 publications

(155 citation statements)

References 8 publications

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“…Patients were allowed home at 16-22 days with a 20 F Foley catheter. After 20 days the pouch was evaluated fluoroscopically with dilute contrast material and saline [1,4]. The pouch was kept drained for 15 days before training by intermittent clamping of the catheter.…”

Section: Methodsmentioning

confidence: 99%

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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: Methodsmentioning

confidence: 99%

“…In this reservoir an intussuscepted nipple valve is used both for continent and antireflux procedures [1]. Skinner et al [2,3] modified the Kock pouch, using a Dexon collar fixation and three rows of staples to fix the valve.…”

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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“…The capacity of an ileal neobladder is in¯uenced by many factors; it has been generally recognized that it strongly depends on the peristaltic activity of the intestinal segment and the shape of the neobladder [1,4,7]. Recon®guration of the intestinal segment by a transection along its antemesenteric edge with subsequent folding has become the classical method [9].…”

Section: Discussionmentioning

confidence: 99%

“…A low-pressure reservoir with a large capacity is the ideal. To increase bladder capacity and prevent high pressure caused by peristalsis, the intestinal segment is detubularized along the antemesenteric border, folded and sutured to form a pouch [1,7]. When conventional detubularization is used tension of the folded mesentery limits the compliance of the intestinal wall and reduces the capacity of the neobladder.…”

Section: Introductionmentioning

confidence: 99%

Perimesenteric detubularization of ileum for ileocystoplasty improves compliance and increases capacity

Nikolayev

2001

BJU International

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Objective To describe a modi®ed form of detubularization using a perimesenteric incision of the ileal segment, which increases the capacity of the neobladder and reduces the length of the ileal segment required. Patients and methods From February 1993 to November 1999, ileocystoplasty was undertaken in 20 patients (mean age 8.4 years, range 4±16). Six had myelodysplasia, four had primary epispadias, ®ve had bladder exstrophy, three had post-traumatic lesions and two had cloacal exstrophy. The patients were divided into two groups; in the ®rst (eight patients, mean age 9.6 years, range 5±15) the ileal segment was opened along the antemesenteric border and in the second (12 patients, mean age 7.7 years, range 4±16) the ileal segment was opened adjacent to the mesentery, perimesenterically. Each segment was then folded and the perimesenteric edges sutured to form the pouch. Results The patients were assessed at 1 year after surgery; the neobladder capacity was evaluated as ((neobladder capacityxbladder capacity)/body weight), which shows the relative increase of bladder capacity after enterocystoplasty per unit of weight.There was a statistically signi®cant increase in neobladder capacity in group 2 (perimesenteric transection; Kruskal±Wallis chi-square, P=0.005; Mann± Whitney U-test, P=0.006). Conclusion These results indicate that augmentation can be carried out by perimesenteric transection of the intestinal segment, which improves compliance and increases capacity of the neobladder.

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“…Nevertheless, the danger to renal function caused by anastomotic stricture that occurs at a higher rate after an antirefluxing technique than after direct anastomosis is well documented 5,12,13 and it is reflected by the number of different antireflux mechanisms developed during the years, such as afferent nipple valves 14 , the Le Duc technique 15 , split-cuff ureteral nipples 16 , the Abol-Enein and Ghoneim technique 17 , the T pouch tecnique 18 and an afferent ileal tubular segment 19 ; however, the multiplicity of these techniques suggests that an ideal solution has not yet been found.…”

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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Urinary Diversion Via a Continent Ileal Reservoir: Clinical Results in 12 Patients

Cited by 608 publications

References 8 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

Perimesenteric detubularization of ileum for ileocystoplasty improves compliance and increases capacity

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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