Presented October 25th - 28th, 2007 at the 2007 Urological Research Society (URS) Meeting - Napa, California

Objective: Urinary diversion following cystectomy can be performed either by standard ileal conduit, ileal- oder ileocecal neobladder or a pouch with an efferent limb to the skin. The principle of the Indiana pouch with a tapered terminal ileum and the ileocecal valve was used for a modified ileocecal pouch with an umbilical stoma.

Methods: after cystectomy a pouch was formed of 30cm ileum and 8-10cm ascending colon. Detubularization and reconfirmation to a pouch was performed. The ureters were implanted in a spatulated end-side fashion preferably into the colon. The efferent limb was constructed out of 5-7 cm terminal ileum. The efferent limb was stapled and tapered over a 12 F red rubber catheter. Inverting non-resorbable Lembert sutures were used to secure and additionally narrow the ileum. The ileocecal valve was also inverted with non-resorbable Lembert sutures. Patency of the ileum for the caheter was repeatedly tested. After rotating the pouch 180o counterclockwise the efferent limb reached to the umbilicus. The efferent limb was sutured to the ventral abdominal wall and a 10Fcatheter left in place until self cath could be started three weeks later. 84 patients were operated. 64 patients (51 females,13 males) had muscle invasive urothelial cancer, 12 were converted from an ileal conduit or an ureteral stoma and 8 patients had non malignant disease (post irradiation, contracted bladder….). 9 patients had their stoma implanted into the right lower abdominal quadrant, 75 had an umbilical stoma. Median follow-up was 5 years.

Results: 82/84 patients were completely dry during catheter intervals. Patients had to catheterize the pouch 0.8 x per night to stay dry. Daytime interval between cath was 4.2h, night time 4.6h. Specific complications included revision of the umbilicus in 6 patients due to catheterisation difficulties, leakage of the pouch in 2 pat., and ureteral stenosis in 5 patients. Functional capacity of the pouch was 550ml (320-740ml), cystometric capacity at 10cmH₂O 490 ml (300-640ml). Maximum pressure was 27cmH₂O and median pressure 18cmH₂O, maximum pressure in the efferent limb was 72cm H₂0 and median pressure 45cmH₂O

Conclusions: The principle of an efferent limb according to the Indiana pouch was used. The ileocecal valve, a tapered efferent ileum, an inverted and narrowed ICV and the isoperisaltic bowel movement in the terminal ileum all add to a continent and reliable stoma. The opening into the umbilicus is preferable for the body image. Long durability of the catheterizable ileum, few complications with stenosis at the umbilicus-ileal anastomosis and a low pressure reservoir lead to high patient satisfaction also in the long run. In comparison to stapled ileocecal pouches or the appendiceal pouch the modified Indiana pouch has a leak point pressure determined by coaptation of tissue in the efferent limb and therefore cannot rupture

Authors: Hofmann R, Olbert P, Hegele A, Schrader A

UroToday.com is grateful to be offered exclusive coverage of the Urological Research Society.

UroToday.com Full Conference Coverage

Please log-in or register in order to submit comments.

Powered by AkoComment!