Serosa Lined and Tapered Ileum as Primary and Secondary Continence Mechanism for Various Catheterizable Pouches

Abstract

Incontinence of catheterizable ileocecal pouches with an umbilical stoma using the original Mainz pouch technique can be repaired by a secondary ileal intussusception nipple fixed in the ileocecal valve. In cases of a modified Mainz pouch with ureteral anastomosis to the prevalvular ileal segment another form of troubleshooting is necessary. In 4 of 112 patients (3.6%) with the modified Mainz pouch described by Roth incontinence or stenosis of the catheterizable stoma occurred. A 24 to 30 cm segment of ileum was isolated. The proximal 8 to 10 cm were tapered and seroserosally embedded in the U-shaped 2 x 8 to 10 cm long remainder of the segment. After excising the insufficient efferent limb this ileal segment was anastomosed to the pouch and the umbilicus with tapered ileum acting as the continence mechanism. In a fifth patient such a segment was used for ileocystoplasty with an umbilical stoma after bladder neck closure. At a median followup of 6 months (range 5 to 64) all 5 patients were fully continent with regular, easy self-catheterization via the umbilicus. The introduced method seems to be a promising continence mechanism for various forms of catheterizable pouches, not only for troubleshooting.