Long-term outcome after urinary diversion using the ileocecal segment in children and adolescents: Complications of the efferent segment

Deuker, Marina; Roos, Frederik C.; Großmann, Allegra; Faé, Patrick; Thüroff, Joachim W.; Stein, Raimund

doi:10.1016/j.jpurol.2016.05.008

Cited by 12 publications

(9 citation statements)

References 25 publications

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“…Bladder perforation, as one of the worst complications, occurred in 6% to 13% . Continent cutaneous catheterizable channels have been shown to have a relatively high revision rate due to stenosis or incontinence of the stoma (up to 50‐60%), depending on the type of channel …”

Section: Procedures To Increase Bladder Capacitymentioning

confidence: 99%

“…15 Continent cutaneous catheterizable channels have been shown to have a relatively high revision rate due to stenosis or incontinence of the stoma (up to 50-60%), depending on the type of channel. 16,17 In addition to surgical complications the metabolic consequences of incorporating bowel segments into the urinary tract have to be taken into account; for example, disturbances of the acid-base balance, vitamin B 12 deficiency and loss of bone density. Stool frequency may increase and diarrhea can occur after the exclusion of bowel segments.…”

Section: Bladder Augmentationmentioning

confidence: 99%

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EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part II operative management

Stein

Bogaert

Doğan

et al. 2019

Neurourology and Urodynamics

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Background: Treatment in children and adolescents with a neurogenic bladder is primarily conservative with the goal of preserving the upper urinary tract combined with a good reservoir function of the bladder. However, sometimeseven in childhood-conservative management does not prevent the development of a low-compliant bladder or overactive detrusor. Material & Methods: After a systematic literature review covering the period 2000-2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update.Results: In these patients, surgical interventions such as botulinum toxin A injections into the detrusor muscle, bladder augmentation, and even urinary diversion may become necessary to preserve the function of the upper (and lower) urinary tracts. The creation of a continent catheterizable channel should be offered to patients with difficulties performing transurethral clean intermittent catheterization. However, a revision rate of up to 50% needs to be considered. With increasing age continence of urine and stool becomes progressively more important. In patients with persistent weak bladder outlets, complete continence can be achieved only by surgical interventions creating a higher resistance/obstruction at the level of the bladder outlet with a success rate of up to 80%. In some patients, bladder neck closure and the creation of a continent catheterizable stoma is an option. Conclusion:In all these patients close follow-up is mandatory to detect surgical complications and metabolic consequences early. K E Y W O R D Sbladder augmentation, bladder neck reconstruction, EAU guideline, Mitrofanoff stoma, neurogenic bladder, sling procedure, urinary diversion

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Section: Procedures To Increase Bladder Capacitymentioning

confidence: 99%

Section: Bladder Augmentationmentioning

confidence: 99%

EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part II operative management

Stein

Bogaert

Doğan

et al. 2019

Neurourology and Urodynamics

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“…There is no consensus on the definition of incontinence in this population. Some authors have used total absence of involuntary loss of urine day and night between catheterizations ( 13 , 15 ). Most publications however, have considered patients socially continent if they were completely dry or used 1 safety pad between catheterizations every 3 hours.…”

Section: Management Of Common Channel Complicationsmentioning

confidence: 99%

“…Stomal stenosis, channel angulation, channel redundancy, channel diverticulum/false passage as well as incontinence as described above are common reasons for revision. In most contemporary published reports, over 90% of CCCs with complications are salvageable with a variety of revision operations ( 11 , 12 , 15 ).…”

Section: Management Of Common Channel Complicationsmentioning

confidence: 99%

Long-term complications of continent catheterizable channels: a problem for transitional urologists

Hampson

Baradaran

Elliott³

2018

Transl. Androl. Urol.

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A majority of the transitional urology patient population have neurogenic bladder and many of these patients have undergone creation of continent catheterizable channels (CCCs) to facilitate bladder emptying. Transitional urologists will be faced with revision of these channels due to a variety of possible complications. We performed a comprehensive literature review to the data regarding the incidence, timing, and predisposing factors that lead to complications of CCCs as well as surgical revision techniques and their outcomes. Long-term channel complications and related revisions are common (25–30%) and likely underestimated. While many predictors for revision have been posited, the only predictor that has been significant in robust multivariable analysis is channel type, with appendicovesicostomies having a lower chance of requiring revision compared to Monti channels. Channels created in adults have high likelihood of requiring revision, even within a relatively short follow-up period. We review techniques for management of channel complications and their outcomes. As patients with congenital urologic conditions requiring CCCs are gaining longer lifespans, transitional urologists will be faced with revision and/or replacement of these channels. While some of these patients may require supravesical diversion in the future, data show that revision is feasible with good outcomes. Longer-term follow-up data is needed to understand the life-span and best practices of new CCCs created among the transitional population.

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“…Die Hauptkomplikationen von Stomata katheterisierbarer Pouches sind die Stomastenosen und die Stomainsuffizienz mit Inkontinenz. Zum Vergleich unserer Ergebnisse greifen wir auf zwei Studien mit hoher Fallzahl (n = 800 und n = 107) zurück [8,9]. Wiesner et al berichten über Stenoseraten von 23,5 % für den Appendixnippel und 15,3 % für den invaginierten Ileumnippel bei einer mittleren Nachbeobachtungszeit von 7,6 Jahren [8].…”

Section: Diskussionunclassified

Langzeitergebnisse des seroserös eingebetteten und getaperten Ileums als efferentes Segment verschiedener Harnableitungsreservoire („Fulda-Nippel“)

et al. 2018

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Zusammenfassung Hintergrund Die Arbeitsgruppe um Kälble stellte 2008 das „Serosa lined and tapered ileum“ („Fulda-Nippel“) als neuen Kontinenzmechanismus des modifizierten MAINZ-Pouch-I vor. In Anlehnung an das Prinzip von Abol-Enein wird ein getapertes Ileumsegment in einen seroserösen Tunnel aus einem zweiten „U“-förmigen Ileumsegment eingebettet. Bei dieser Technik werden Kontinenzmechanismus und Augmentation miteinander kombiniert. Sie kann in allen Pouchformen und auch als kontinente Vesikostomie genutzt werden. Patienten und Methoden In der urologischen Klinik des Universitätsklinikums Bonn wurde diese Technik seit 2008 in bisher 21 Fällen bei unterschiedlichen Indikationen verwendet. In der ersten Analyse von 2011 konnte der Nippel bereits durch geringe Frühkomplikationsraten überzeugen. Ziel dieser Studie ist die Re-Evaluation der Technik insbesondere im Hinblick auf Stenose- und Inkontinenzraten im Langzeitverlauf. Ergebnisse Bei einer mittleren Nachbeobachtungszeit von 37 Monaten traten Stomastenosen in 33 % der Fälle auf. Eine Inkontinenz des Nippels wurde bei 21 % (n = 4) der Patienten beobachtet. Bei zwei der Patienten war die Ursache der Inkontinenz das komplette Ausgleiten des Nippels aus der seroserösen Einbettung. Schlussfolgerung In der Langzeitanalyse zeigen sich ähnliche Stenose- und Inkontinenzraten im Vergleich zu den zwei etabliertesten Techniken, dem Appendixnippel und dem Ileuminvaginationsnippel. Trotz Limitation aufgrund der kleinen Fallzahl ist der Fulda-Nippel zumindest als eine adäquate „Zweitlinientechnik“ bei Versagen der initialen Methode anzusehen. Als Vesikostomie bietet der Fulda-Nippel den Vorteil, Augmentation und Kontinenzmechanismus elegant miteinander zu vereinen und sollte hier auch als Primärtechnik Verwendung finden.

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Long-term outcome after urinary diversion using the ileocecal segment in children and adolescents: Complications of the efferent segment

Cited by 12 publications

References 25 publications

EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part II operative management

EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part II operative management

Long-term complications of continent catheterizable channels: a problem for transitional urologists

Langzeitergebnisse des seroserös eingebetteten und getaperten Ileums als efferentes Segment verschiedener Harnableitungsreservoire („Fulda-Nippel“)

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