Continent urinary reservoir formation with transverse colon for patients with pelvic irradiation

Abstract

Background : The creation of a continent transverse colon pouch for patients who had previously received radiation therapy for cervical cancer was attempted. Methods : Three patients underwent construction of a continent urinary reservoir. Approximately 30 cm of a transverse colon segment was isolated for constructing a pouch. A reconfigured colon segment was used in two cases as a continent valve and the appendix was used in one case. Both ureters were implanted submucosally into the pouch in two patients and a reconfigured colon was also used to reconstruct a defect of the ureter in one patient.Results : All patients could catheterize the pouch easily via the cutaneous stoma without incontinence. No complications were noted. Conclusions : In the event that a urinary diversion is necessary for a pateint who has previously had radiation therapy, the transverse colon pouch can be a useful method to improve the quality of life. In addition, versatility of the reconfigured colon segment enables the colon pouch to be adapted to adverse clinical stiuations.

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

“…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 use of colon conduit may be critically important because it is closer to the reservoir in comparison with other segments [5]. The patient had an uneventful recovery, with continence and utilizing clean intermittent self-catheterization.…”

“…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.…”

Harnableitung und Dickdarm

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

Colon pouch (Mainz III) for continent urinary diversion

“…Some prefer to use ileum (i.e. Kock, T‐pouches), others the ileo‐caecum (Mainz I, Penn, Indiana, Lund, Lundina, Miami, Florida pouches), or colon (Mainz III pouch) [3–13]. The larger diameter of the colon gives a higher capacity than ileum when the same length is used to create the reservoir.…”