1166 SECONDARY INTUSSUSCEPTED ILEAL NIPPLE VALVE IN CONTINENT CUTANEOUS URINARY DIVERSION SURGICAL TECHNIQUE AND LONG-TERM RESULTS

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20121166 SECONDARY INTUSSUSCEPTED ILEAL NIPPLE VALVE IN CONTINENT CUTANEOUS URINARY DIVERSION SURGICAL TECHNIQUE AND LONG-TERM RESULTS Arkadius Kocot, Martin Spahn, Daniel Vergho, Andreas Loeser, and Hubertus Riedmiller Arkadius KocotArkadius Kocot Wuerzburg, Germany More articles by this author , Martin SpahnMartin Spahn Wuerzburg, Germany More articles by this author , Daniel VerghoDaniel Vergho Wuerzburg, Germany More articles by this author , Andreas LoeserAndreas Loeser Wuerzburg, Germany More articles by this author , and Hubertus RiedmillerHubertus Riedmiller Wuerzburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1390AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To critically assess safety and long-term outcome of secondary intussuscepted ileal nipple valve (IINV) in complex reconstruction and troubleshooting of continent cutaneous ileocaecal reservoirs (CCIR) or conversion from orthotopic ileocaecal bladder substitutes into CCIR. METHODS From May 1997 to June 2011 73 patients with CCIR underwent surgical minor and major revisions of their cutaneous continence mechanisms (men: n=38, women: n=35). Retrospectively 12 patients have been identified who suffered from otherwise intractable defects of their cutaneous outlets (appendix stoma: n=6, primary IINV: n=3, Monti-outlet: n=3) resulting in impaired clean intermittent self-catheterization (CIC) and/or urinary incontinence. Two further patients needed a conversion from an orthotopic ileocaecal bladder substitute into CCIR due to urethral recurrence of their primary transitional cell carcinoma. The mean interval between primary continent urinary diversion and creation auf the secondary IINV was 26,4 months. In all 14 patients (mean age 49,8 years, 6 women) a secondary IINV has been created using 10-12 cm of isolated and isoperistaltic intussuscepted ileal segment with consecutive stapler fixation in the ileocaecal valve. In all cases the umbilicus was chosen as the preferred site of the stoma. RESULTS Postoperatively all patients were continent day and night with ease of catheterization. The mean follow-up was 53, 9 (range 2–159) months. In a long term setting no stoma stenosis was observed. Two patients required re-fixation of the secondary IINV due to nipple gliding within the ileocaecal valve 36 and 54 months after surgery. After traumatic CIC in one further patient with consecutive via falsa in the cutaneous outlet open revision with successful closure of the defect could be achieved three months after secondary IINV. CONCLUSIONS The secondary ileal intussuscepted nipple valve is a safe and reliable solution in complex reconstruction and troubleshooting of continent cutaneous urinary reservoirs. Possible long–term complications like nipple gliding are controllable. Furthermore this surgical technique may be used to convert orthotopic ileocaecal reservoirs into a CCIR. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e472-e473 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arkadius Kocot Wuerzburg, Germany More articles by this author Martin Spahn Wuerzburg, Germany More articles by this author Daniel Vergho Wuerzburg, Germany More articles by this author Andreas Loeser Wuerzburg, Germany More articles by this author Hubertus Riedmiller Wuerzburg, Germany More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...