Long-term follow-up after ileocaecal continent cutaneous urinary diversion (Mainz I pouch): A retrospective study of a monocentric experience

Abstract

ObjectiveTo assess the long-term follow-up after ileocaecal continent cutaneous reservoir (ICCR) and to review the late complications.Patients and methodsIn all, 756 patients underwent an ICCR in our department, with long-term follow-up data available in 50 patients. The inclusion criterion was ICCR regardless of the indication and the exclusion criteria were orthotopic neobladder or other continent urinary diversions not performed with the ileocaecum. Patients were followed to record primary outcomes and late complications. Complications were stratified according to the Clavien–Dindo classification.ResultsThe mean patient age was 44 years and pelvic malignancies were the first indication for urinary diversion. The mean (range) follow-up was 19 (9–36) years. A stoma stenosis was the most frequent outlet-related complication requiring re-intervention, followed by ischaemic outlet degeneration, and stoma incontinence. Six renal units (RUs) developed obstruction at the anastomotic site and were managed by open surgery. Three RUs had to be removed due to deterioration. A dederivation was necessary in three patients (6%).ConclusionThe ICCR is a safe and established technique when an orthotopic pouch is impossible. The long-term follow-up shows acceptable complication rates and satisfactory continence conditions. However, large population studies are necessary to confirm this observation.

Modern view on the problem of urine diversion in children with severe urinary disorders

“…Для достижения континенции используют: инвагинированный сегмент подвздошной кишки (Kock pouch), баугиниеву заслонку с пликацией сегмента подвздошной кишки (Mainz pouch I), приводящий сегмент подвздошной кишки с пликацией (Indiana pouch). Во всех вышеперечисленных операциях наиболее важные моменты -детубуляризация и реконфигурация кишечного сегмента для создания резервуара большой емкости с низким давлением, формирование клапана для удержания и защита верхних мочевых путей от рефлюкса [19].…”