Complications Related to Different Continence Mechanisms in Ileocecal Reservoirs

Gerharz, Elmar W.; Köhl, Ulrich; Weingärtner, K.; Melekos, Michael D.; Bonfig, Roland; Riedmiller, H.

doi:10.1016/s0022-5347(01)64105-3

Cited by 40 publications

(15 citation statements)

References 24 publications

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“…Urinary incontinence remains one of the most common problems of cutaneous continent diversions, and its degree significantly determines a patient's quality of life [1,3,7,9]. Few comparative studies indicate that the appendix seems to be superior to ileal segments concerning urodynamic characteristics (functional length, static and/or dynamic closure pressure) and complication rates.…”

Section: Discussionmentioning

confidence: 99%

“…Few comparative studies indicate that the appendix seems to be superior to ileal segments concerning urodynamic characteristics (functional length, static and/or dynamic closure pressure) and complication rates. However, in case of prior appendectomy or unsuitable appendix, other forms of efferent outlets are necessary [8,9,10]. …”

Section: Discussionmentioning

confidence: 99%

“…Only a few comparative studies regarding the outcome of efferent segments have been published. It seems that the submucosally embedded in situ appendix seems to be superior to other efferent segments [8,9]. Three types of efferent segments can be distinguished in constructing continent cutaneous diversions: nipple, flap and hydraulic valves.…”

Section: Introductionmentioning

confidence: 99%

“…The degree of incontinence essentially determinates the surgical success and the patients' quality of life [1,3,7,9]. Few urodynamic studies in urinary diversions have been published.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Meaning of Urodynamic Studies in Pouch Incontinence: Results of a Small Series

Latz

Achterberg²,

Ellinger³

et al. 2013

Urol Int

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Introduction: To evaluate the meaning of urodynamic parameters in patients with pouch incontinence. Materials and Methods: Thirteen urodynamic studies in patients with an ileal nipple as the efferent segment of an ileocecal pouch or ileum/ileocecal-augmented bladder were performed. The recorded parameters included pouch capacity, leak point pressure/volume, maximum pouch pressure, compliance, static and dynamic closure pressure, and functional length. Three patients suffered from urinary incontinence. Results: In all cases of incontinent patients, no functional length or static or dynamic closure pressure could be revealed. In 8 of 10 cases of continent patients, a positive functional length as well as static and/or dynamic closure pressure were measured (mean value in continent patients: 15.9 mm, 14.5 cm H₂O and 26.5 cm H₂O, respectively). In 2 of 3 cases of incontinent patients, the pouch compliance was restricted (21 and 37 ml/cm H₂O). The pouch capacity of continent patients was greater than the capacity of incontinent patients (377.4 vs. 185.7 ml). Conclusions: Positive functional length, static and dynamic closure pressures, and a high pouch capacity with an unrestricted compliance are predictive for pouch continence. They may individually not determine continence, but combining them can. However, the meaning of urodynamic studies in pouch incontinence is not the same as with the urinary bladder.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The degree of incontinence essentially determinates the surgical success and the patients' quality of life [1,3,7,9]. Few urodynamic studies in urinary diversions have been published.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic Meaning of Urodynamic Studies in Pouch Incontinence: Results of a Small Series

Latz

Achterberg²,

Ellinger³

et al. 2013

Urol Int

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“…Catheterization problems are even met more frequently (60%) in Yang-Monti ileovesicostomy, so generally this procedure is rarely advocated in cases with a missing or unsuitable appendix [13] . Incontinence due to the nipple-gliding phenomenon or ischemia with a reoperation rate of 12.3% in pouches following the hydrostatic nipple valve principle of intussuscepted ileum are for example likely to banish this ambitious technique slowly from the widespread spectrum of urinary diversion [7] . Urologists would be well advised not to get lost in space and focus their skills on two techniques, namely establishing a continent cutaneous pouch in patients with an appendix and in those without.…”

Section: Discussionmentioning

confidence: 99%

Evoluting the Invaginated – One Step Closer to the Perfect Valve Modified Serosal Lined Tapered Ileum (Kälble’s Procedure) as a Continence Mechanism for Catheterizable Pouches

Fechner

Rogenhofer²,

Hauser³

et al. 2011

Urol Int

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Introduction: A sufficient and easily catheterizable continence mechanism is essential in continent cutaneous pouches. Kälble embedded a tapered ileum as efferent segment into a serosal lined tunnel formed by an ileal ‘U’ according to the principle of Abol-Enein and Ghoneim. We report a modified technique applied in a series of 12 patients who had undergone different urinary diversions. Methods: All patients received a modified Kälble procedure (first-line urinary diversion, n = 8; revision/undiversion, n = 4) for different forms of continent pouches. To alleviate embedding of the efferent segment, ileal detubularization was performed asymmetrically. Mean follow-up was 9.5 months. Results: All patients were continent and performed self-catheterization easily. Of 12 patients, 2 underwent endoscopic incision for stomal stenosis 8 and 12 months postoperatively. Conclusions: Subject to our short follow-up, Kälble’s technique is a promising alternative in patients undergoing a continent cutaneous urinary diversion but offers an inapplicable or missing appendix.

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Continent cutaneous diversion

Neisius¹,

Thüroff²

2015

Bladder Cancer

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Complications Related to Different Continence Mechanisms in Ileocecal Reservoirs

Cited by 40 publications

References 24 publications

Diagnostic Meaning of Urodynamic Studies in Pouch Incontinence: Results of a Small Series

Diagnostic Meaning of Urodynamic Studies in Pouch Incontinence: Results of a Small Series

Evoluting the Invaginated – One Step Closer to the Perfect Valve Modified Serosal Lined Tapered Ileum (Kälble’s Procedure) as a Continence Mechanism for Catheterizable Pouches

Continent cutaneous diversion

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