Ten Years&amp;rsquo; Experience with the Submucosally Embedded in situ Appendix in Continent Cutaneous Diversion

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

doi:10.1159/000049848

Cited by 25 publications

(6 citation statements)

References 36 publications

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“…Gerharz et al . [19] have published their results of using submucosally embedded appendix in a continent cutaneous diversion in the Mainz I pouch in 118 patients with a mean follow-up of 60 months. The indication for this surgery in 98 of the 118 patients was pelvic malignancy; this contrasts with the benign bladder disease or bladder dysfunction that are included in most of the published series detailed above.…”

Section: Discussionmentioning

confidence: 99%

The continent, catheterizable abdominal conduit in adult urological practice

2008

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OBJECTIVE To report a large, single‐centre experience with a continent, catheterizable abdominal conduit in adult patients. PATIENTS AND METHODS We retrospectively reviewed the case notes of all 65 patients who had surgery to create a continent catheterizable conduit based on the Mitrofanoff principle. Operations were carried out over a 13‐year period. Data on surgical procedure, complications and final outcome were collected and analysed. RESULTS The mean age of the patients was 38.4 years and mean follow‐up interval was 75.2 months. Patients with neuropathic lower urinary tracts accounted for the largest single indication for reconstruction (36 patients). The appendix was the conduit of choice and was available and suitable for use in 37 patients. There were 57 patients who continued to use their native bladder or had undergone an augmentation or substitution cystoplasty; 24.5% of these 57 individuals had also undergone closure of the bladder neck or urethra. There were postoperative complications requiring laparotomy in five (8%) patients. In all, 30 patients (46%) had catheterization problems, but most of these were easy to treat. Five patients (8%) had an incontinent conduit which was a more difficult problem to deal with. Two patients have died of unrelated cause and five patients have been converted to an ileal conduit. In all, 58 patients (92%) now have a Mitrofanoff conduit, of which 97% are catheterizable and 95% are continent. CONCLUSIONS Continent urinary diversion, based on the Mitrofanoff principle, has similar outcomes in adult urological practice to those described in published paediatric case series. There is good evidence to suggest that Mitrofanoff conduits are durable. However, patients should be aware of complications and the need for long‐term follow‐up.

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Section: Discussionmentioning

confidence: 99%

The continent, catheterizable abdominal conduit in adult urological practice

2008

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“…Stomal stenosis is common after diversion using small‐bore outlets, i.e. the appendix [21]. Although the stoma most often can be revised as an outpatient procedure, it is nevertheless annoying to the patient.…”

Section: Discussionmentioning

confidence: 99%

Continent urinary tract reconstruction – the Lund experience

Månsson¹,

Davidsson²,

Könyves³

et al. 2003

BJU International

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The Department of Urology in Lund, Sweden, has a long association with innovations in reconstructive urology. The authors from that department describe their experience over a long period with orthotopic bladder substitution and continent cutaneous urinary diversion. They conclude that continent urinary tract reconstruction is associated with a high incidence of early and late complications. They also found that for storage and emptying, their Lundiana pouch was superior to the Goldwasser neobladder. OBJECTIVE To assess the early and late complications and functional results in patients undergoing continent reconstruction of the urinary tract, i.e. orthotopic bladder substitution (OBS) or continent cutaneous diversion (CCD). PATIENTS AND METHODS The medical records of all patients undergoing OBS (Goldwasser technique) or CCD (‘Lundiana’ technique) for malignant or benign disease during 1987–1999 and followed to December 2001 were reviewed. There were 67 patients with neobladders, 77 with a Lundiana pouch who had undergone radical cystectomy and 22 with a Lundiana pouch operated for benign disorders. RESULTS Early complications requiring reoperation occurred in 12% of the cystectomy group, with no difference with type of reconstruction, and in 10% with benign diseases. Four patients (3%) undergoing radical cystectomy died from early cardiovascular complications, two after surgery for intra‐abdominal complications. Intestinally related complications and wound dehiscence requiring re‐operation occurred in nine and six patients, respectively. The incidence of late complications requiring open surgery was 22% and 23% after cystectomy with OBS and CCD, respectively. The value in patients with benign diseases undergoing CCD was also 23%. Stone formation in the pouch was common, occurring in 12% in patients with OBS and in 10% after CCD. The pouch perforated or ruptured in four patients. The incidence of uretero‐intestinal stricture using the Le Duc technique was 2.4% and renal function was well preserved. The incidence of revisional surgery of the Lundiana pouch outlet for incontinence was low and all patients but four were continent. The functional outcome in patients with OBS was less good; some needed pouch augmentation or an artificial urinary sphincter. Most patients used incontinence products and many needed clean intermittent self‐catheterization. CONCLUSION Continent urinary tract reconstruction is associated with a high incidence of early and late complications. For storage and emptying, the CCD Lundiana pouch is superior to the OBS of Goldwasser.

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“…At present, the prevention of nipple gliding in general deserves increased attention. Gerharz et al [66]. reported nipple gliding in 6.6% of cases and the need for a revision in 12.3%.…”

Section: The Nipple Valve Principlementioning

confidence: 98%

The efferent segment in continent cutaneous urinary diversion: a comprehensive review of the literature

Ardelt

Woodhouse

Riedmiller³

et al. 2011

BJU International

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Study Type – Prognosis (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? While the ileal conduit and orthotopic neobladder are the most commonly used diversions today, continent cutaneous reservoirs remain an invaluable treatment option for a well‐defined subset of indications. After several decades of surgical experience a continuous optimisation process, especially for the continence mechanism, is still ongoing. The continence mechanism largely determines the treatment success in terms of patient satisfaction and quality of life. At present, no consensus has been reached regarding an optimal technique. Common problems include stomal stenosis with impaired catheterisation, urinary incontinence, and nipple gliding. This review critically examines published reports on the various efferent segments used in continent catheterisable urinary reservoirs. It compares data regarding the complications as well as clinical performance. Hence, it provides a valuable comparison and insight into some of the biophysical properties, shortcomings and complications of the different outlets. Also, this view clearly demonstrates that literature evidence for each technique remains poor. OBJECTIVE • To critically assess the biophysical properties and current status of outlet formation in heterotopic intestinal urinary diversion. As despite three decades of clinical experience with continent cutaneous urinary diversion through bowel segments, no consensus has been reached for the optimal efferent segment although its function largely determines patient satisfaction. METHODS • A comprehensive Medline literature search using the Medical Subject Headings database (search terms: continent urinary diversion followed by either efferent segment, nipple, Mitrofanoff, Yang‐Monti, Benchekroun, tapered ileum, intussuscepted ileum, Kock pouch, T‐valve, or Ghonheim) was conducted to identify all full‐length original articles addressing the various principles and techniques of outlet formation as well as their outcomes and complications. • Examined series were published in English between 1966 and 2010. • All studies were systematically evaluated using a checklist (study design, number of patients, etc.) and rated according to the Oxford Centre for Evidence‐Based Medicine Levels of Evidence (LoE). RESULTS • While there was a continuous flow of publications over the last three decades, the vast majority of studies were retrospective case series with numerous confounding factors and poorly defined, non‐standardized outcomes (LoE, 3). Only a few investigations compare different efferent segments (LoE, 2a). • No randomized studies exist. • The major biophysical principles are based on the use of flap, nipple, and hydraulic valves. • Vermiform appendix, intussuscepted ileal nipple, and the Yang‐Monti tube are the most popular techniques and have well‐established data on outcomes, complications, and failure rates. • Artificial sphincter systems and tissue engineering have provided disappointing results thus far. M...

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Ten Years’ Experience with the Submucosally Embedded in situ Appendix in Continent Cutaneous Diversion

Cited by 25 publications

References 36 publications

The continent, catheterizable abdominal conduit in adult urological practice

The continent, catheterizable abdominal conduit in adult urological practice

Continent urinary tract reconstruction – the Lund experience

The efferent segment in continent cutaneous urinary diversion: a comprehensive review of the literature

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