Long-Term Followup of the Intussuscepted Ileal Nipple and the In Situ, Submucosally Embedded Appendix as Continence Mechanisms of Continent Urinary Diversion With the Cutaneous Ileocecal Pouch (Mainz Pouch I)

Wiesner, Christoph; Stein, Raimund; Pahernik, Sascha; Hahn, Karen; Melchior, Sebastian; Thüroff, Joachim W.

doi:10.1016/s0022-5347(06)00571-4

Cited by 53 publications

(27 citation statements)

References 17 publications

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“…5,14 Among 144 adults, Wiesner et al reported 17% revision rate for stomal stenosis; the mean time to stenosis was 43.8 months. 6 Redshaw et al in a study of 61 adult patients with cutaneous catheterizable ileal cecocystoplasty found only 3-13% stenosis rate with a relatively short follow-Surgical revision of catheterizable channel obstruction up of 16 months. 4 Durability of these reconstructions is unknown.…”

Section: Discussionmentioning

confidence: 97%

Outcomes of revision surgery for difficult to catheterize continent channels in a multi-institutional cohort of adults

Pagliara¹,

Gor

Liberman³

et al. 2017

CUAJ

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Introduction: We aimed to describe the strategies of surgical revision for catheterizable channel obstruction and their outcomes, including restenosis and new channel incontinence. Methods: We retrospectively queried the charts of adults who underwent catheterizable channel revision or replacement from 2000-2014 for stomal stenosis, channel obstruction, or difficulty with catheterization at the Universities of Minnesota, Michigan, and Utah. The primary endpoint was channel patency as measured by freedom from repeat surgical intervention. Secondary endpoints included post-revision incontinence and complication rates. Revision surgeries were classified by strategy into "above fascia," "below fascia," and "channel replacement" groupings. Results: A total of 51 patients who underwent 68 repairs (age 18-82 years old; mean 45) were identified who met our inclusion criteria. Channel patency was achieved in 66% at a median 19 months post-revision for all repair types. There was no difference in patency by the type of channel being revised, but there was based on revision technique, with channel replacement and above the fascia repairs being more successful (p=0.046). Channel incontinence occurred in 40% and was moderate to severe in 12%. The type of channel being revised was strongly associated (p=0.003) with any postoperative channel incontinence. Surgical complications occurred in 29% of all revision procedures, although most were low-grade. Conclusions: Surgical revision of continent catheterizable channels for channel obstruction can be performed with acceptable rates of durable patency and incontinence; however, the surgeon needs to have experience in complex urinary diversion and familiarity with a variety of surgical revision strategies.

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Section: Discussionmentioning

confidence: 97%

Outcomes of revision surgery for difficult to catheterize continent channels in a multi-institutional cohort of adults

Pagliara¹,

Gor

Liberman³

et al. 2017

CUAJ

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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%

“…However, continent cutaneous diversions are treatment options in several indications like previous or synchronous urethral tumor, neurogenic incontinence and bladder extrophy [1,2,3]. Low-pressure and large-capacity reservoirs as well as a safe, simple and reliable continence mechanism are common requirements for cutaneous ileocecal pouches [2,4,5,6,7].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…Seit über 30 Jahren wird das Verfahren der kontinenten Harnableitung durch Darmsegmente angewandt [1,5,12,15,19,22,23,27,28]. Wäh-rend dieser Zeit lag das Bestreben in einer fortwährenden Verbesserung und Reproduzierbarkeit der verschiedenen Techniken.…”

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Katheterisierbarer Kontinenzmechanismus für verschiedene Harnableitungsreservoire

Anheuser

Kranz

Rausch

et al. 2012

Urologe

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In a retrospective multicenter study of four clinics perioperative complications as well as incontinence and stoma stenosis of serosa-lined tapered ileum as catheterizable continence mechanisms for different urinary diversions were analyzed. Between 2008 and 2012 a total of 40 patients received a continent catheterizablestoma, 15 (37.5%) in combination with continent vesicostomy and closure of the bladder neck due to postoperative incontinence and recurrent stenosis including radical prostatectomy, transurethral resection (TUR) of the prostate, bladder neck incision (n=11), neurogenic bladder with reduced capacity and incontinence (n=2), interstitial cystitis (n=1) and recurrent urethral tumor following ileal neobladder (n=1). Of the patients 25 (62.5%) received this continence mechanism in combination with a modified Mainz pouch I, in 19 patients as primary and in 6 patients as secondary efferent segment for trouble shooting. The complications were subdivided according the Clavien classification. In 29 patients information concerning continence and stenosis were obtained, the median follow-up was 25 months (range 1-111 months). In patients with continent vesicostomy (n=11) the incontinence rate was 9.1% (1/11) and the stenosis rate 18.2% (2/11). In 18 patients with an ileocecal pouch, incontinence and stenosis rates were 0% and 11.1% (2/18), respectively. The presented technique is a safe continence mechanism for various catheterizable continent urinary diversions for both primary and secondary indications.

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Long-Term Followup of the Intussuscepted Ileal Nipple and the In Situ, Submucosally Embedded Appendix as Continence Mechanisms of Continent Urinary Diversion With the Cutaneous Ileocecal Pouch (Mainz Pouch I)

Cited by 53 publications

References 17 publications

Outcomes of revision surgery for difficult to catheterize continent channels in a multi-institutional cohort of adults

Outcomes of revision surgery for difficult to catheterize continent channels in a multi-institutional cohort of adults

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

Katheterisierbarer Kontinenzmechanismus für verschiedene Harnableitungsreservoire

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