Ileal Urinary Reservoir Research Articles

Rectal Tumor With Perineal Invasion and Peritoneal Carcinomatosis: Pelvic Exenteration Followed by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy - A Case Report

Background: Pelvic exenteration is an established treatment option for locally advanced rectal cancer. However, only a few studies evaluate the important role of such procedure, due to its morbidity and exclusion criteria. This study will indicate the rare and successful association of cytoreductive surgery (CRS), total pelvic exenteration, abdominoperineal amputation, ileal urinary reservoir, peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC), in a patient with preoperative diagnosis of rectal tumor with perineal invasion and peritoneal carcinomatosis in the pelvis, in a brazilian surgery service.

Ileal Urinary Reservoir in Pediatric Population: Objective Assessment of Long-term Sequelae With Time-to-event Analysis

To evaluate the long-term outcomes of an ileal urinary reservoir in children. This was a longitudinal study of pediatric patients who had undergone total ileal substitution of the bladder. Continence status was assessed, and all patients were evaluated for kidney function and biochemical profile. Standardized growth charts were used to assess linear growth. To assess bone mineral density, dual-emission x-ray absorptiometry scanning was performed. Clavien's scale was used to report and grade the long-term complications and their timing. We used a simple quality of life questionnaire to assess the effect of the procedure on the quality of life of the growing child. A total of 17 patients were included; 3 with orthotopic and 14 with continent cutaneous reservoirs. After a mean follow-up of 87.3 months, all patients were voiding with clean intermittent catheterization, with a 94% final continence rate. Two patients (11.7%) had an estimated glomerular filtration rate of ≤ 45 mL/min/1.73 m(2) at the last follow-up examination. However, no clinically manifest metabolic acidosis was detected. No anemia or neurologic deficit was detected, with a low-normal serum level of vitamin B(12) in 2 patients (11.7%) and a low level in 1 patient (5.7%). One patient (5.7%) had chronic diarrhea. Low bone mineral density was found in 4 patients (22.8%), with 3 patients (17.1%) not exceeding the fifth percentile of height for age. High-grade complications (grade 3a-5) represented 64.5% of the complications, and the need for reintervention occurred late in the follow-up period. A high level of quality of life satisfaction was reported (88.5%). Ileal neobladder construction allows child to pass into adolescence dry with more confidence and self-esteem, with no external urine collection set. However, long-term follow-up is mandatory to maintain the positive outcome.

MP-11.06 Ileal Neobladder in Pediatric Population: Objective Assessment of the Long-Term Sequelae

To evaluate the long-term outcome of an ileal urinary reservoir in children.

Determinants of bone loss in patients with Kock ileal urinary reservoir.

The purpose of the present study was to determine the change in bone mineral density (BMD) measured with dual energy X-ray absorptiometry (DXA) in patients with Kock reservoirs for urinary diversion who were examined with the same technique 3 years earlier, and relate the changes to kidney function and variables reflecting bone metabolism. A total of 28 patients with Kock ileal reservoirs to the skin (23) or urethra (5) were reinvestigated 3 years after the first measurement. BMD was measured in the lumbar spine, femur and whole body with DXA. Bone specific alkaline phosphatase, osteocalcin, parathyroid hormone (PTH), calcitonin and chloride were also determined in serum. GFR was determined from the plasma clearance of 51Cr-EDTA. The mean values for BMD expressed in percentage of corresponding mean values for age-matched controls (BMD%) were almost identical after 3 years. Only osteocalcin levels correlated with the BMD% values. However, significant positive correlations were found between GFR and the observed individual changes in BMD% over the 3 years in spite of the fact that most GFR values were fairly normal. Enhanced bone loss was associated with high concentrations of osteocalcin and bone specific alkaline phosphatase. Comparisons with blood gas analyses and determination of 1,25 dihydroxyvitamin D performed in the previous study indicate to us that the relation between reduced GFR and low mineral content might, in part, be related to a low-grade metabolic acidosis and reduced availability of the biologically active vitamin D hormone. The conclusion to be drawn is that urinary diversion with a Kock reservoir does not regularly cause bone demineralization. However, patients with even moderately reduced GFR appear to be at risk for developing osteoporosis in the long-time run.

Wall-incorporated antireflux valve in ileal bladder substitutes: first clinical experience in 17 patients

Objectives. To report on the initial clinical results of a novel technique of a wall-incorporated antireflux valve in ileal urinary reservoirs. Methods. Forty-five centimeters of the terminal ileum were isolated. A double-folded pouch was created using the distal 42 cm, of which the distal 35 cm was detubularized and the proximal 7 cm was left intact to act as a valve. Suturing at the borders of the valve was performed so that the valve formed part of the pouch wall. The technique was carried out in 17 patients. The mean follow-up period was 24 months (range 12 to 44). The patients were evaluated clinically and radiologically. Endoscopic examination was carried out in 3 patients. Results. None of 17 patients showed reflux on ascending cystography. Excretory urography revealed stable or improved upper tracts in 33 renal units. Hydroureteronephrosis was found in one unit because of ureteroileal stenosis that required operative correction. All patients were continent during the day. Night wetting occurred in 2 patients; imipramine hydrochloride therapy resulted in a complete response in 1 patient and partial improvement in the other. Conclusions. The preliminary results of wall-incorporated antireflux valve are encouraging. It is technically simple and easy. It is not time consuming and requires a shorter ileal segment than that required for the intussuscepted valve. Staples are not used. The vascular pedicle is not manipulated. The wall-incorporated valve is suitable for the normal, dilated, or short ureter. Despite limited clinical experience, the valve may provide a reliable technique for reflux prevention in bladder substitutes.

BILE ACID MALABSORPTION AFTER CONTINENT URINARY DIVERSION WITH AN ILEAL RESERVOIR

Purpose We determine the effect of urinary diversion with a Kock ileal reservoir on bile acid absorption and bowel habits. Materials and Methods We asked 96 patients with a Kock ileal urinary reservoir to record bowel habits and abdominal symptoms for 1 week. Data on 75 patients were further analyzed. Bile acid absorption was determined in 29 healthy control subjects, in 17 before and 6 months after continent urinary diversion, and in 21, 2 to 14 years postoperatively. Bile acid absorption was considered pathological when retention of less than 10% of an oral capsule containing selenium-75 labeled tauroselcholic acid (SeHCAT) was noted after 1 week. Results Mean number of defecations plus or minus standard deviation was 9.4 +/- 6.1 (75 cases). Of the patients 13% had 15 or more stools per week and 15% complained of always having loose stools. Mean value for the SeHCAT test was 32 +/- 19% preoperatively and 17 +/- 16% 6 months postoperatively (p = 0.0023). The corresponding value for healthy controls was 39 +/- 18%. Significant relationships were found between the results of the SeHCAT test postoperatively, and the number of stools per week and consistency of the feces. All patients with more than 10 defecations per week had a pathological SeHCAT test. Conclusions Most patients with an ileal urinary reservoir have fairly normal bowel habits. Bile acid absorption is significantly reduced postoperatively and approximately a third of the patients have a pathological SeHCAT test. Preoperative investigation of bowel habits is recommended and a SeHCAT test should be performed in patients with frequent, loose defecations. Other types of diversion should be offered when preoperative retention is below 10 to 20% especially in patients with impaired anal control.

Bile acid malabsorption after continent urinary diversion with an ileal reservoir.

We determine the effect of urinary diversion with a Kock ileal reservoir on bile acid absorption and bowel habits. We asked 96 patients with a Kock ileal urinary reservoir to record bowel habits and abdominal symptoms for 1 week. Data on 75 patients were further analyzed. Bile acid absorption was determined in 29 healthy control subjects, in 17 before and 6 months after continent urinary diversion, and in 21, 2 to 14 years postoperatively. Bile acid absorption was considered pathological when retention of less than 10% of an oral capsule containing selenium-75 labeled tauroselcholic acid (SeHCAT) was noted after 1 week. Mean number of defecations plus or minus standard deviation was 9.4 +/- 6.1 (75 cases). Of the patients 13% had 15 or more stools per week and 15% complained of always having loose stools. Mean value for the SeHCAT test was 32 +/- 19% preoperatively and 17 +/- 16% 6 months postoperatively (p = 0.0023). The corresponding value for healthy controls was 39 +/- 18%. Significant relationships were found between the results of the SeHCAT test postoperatively, and the number of stools per week and consistency of the feces. All patients with more than 10 defecations per week had a pathological SeHCAT test. Most patients with an ileal urinary reservoir have fairly normal bowel habits. Bile acid absorption is significantly reduced postoperatively and approximately a third of the patients have a pathological SeHCAT test. Preoperative investigation of bowel habits is recommended and a SeHCAT test should be performed in patients with frequent, loose defecations. Other types of diversion should be offered when preoperative retention is below 10 to 20% especially in patients with impaired anal control.

Crypt cell thymidine incorporation in ileal urinary pouch. Preliminary report.

This is a brief communication about mucosal change in ileal urinary reservoirs, the earliest reported observations to date. Previous authors described early villous atrophy and crypt elongation, late panmucosal atrophy and metaplasia. Crypt cell proliferation should be a forerunner of these events and therefore warrants quantitative measurement. We studied continent pouches in dogs on postoperative days 42 and 43 using in vivo tritiated thymidine incorporation into crypt cell DNA, a novel application of autoradiography for urinary reservoirs. Adjacent normal ileum provided the internal control. Increased crypt cell thymidine incorporation was confirmed at this early time.

Functional characteristics and follow-up of the continent ileal colonic urinary reservoir

Functional characteristics and follow-up of the continent ileal colonic urinary reservoir

Study of antireflux nipple valves of Kock ileal urinary reservoir experimental investigation in dogs

To better assess the construction, maintenance, and function of the Kock ileal urinary reservoir with its continent antirefluxing nipple valves, laboratory investigations in dogs were done simultaneously with clinical trials in humans in 1983. Fifteen dogs underwent creation of hemi-Kock ileal reservoirs (without the efferent valve and limb) that were anastomosed to their bladders as enterocystoplasties. The afferent antirefluxing nipple valves were intussuscepted after 7 cm of underlying mesentery had been removed. The nipples were further stabilized with metal and absorbable (Polysorb) staples and Marlex collars. The right ureters were anastomosed to the afferent limb of the reservoirs with the contralateral systems left intact as controls. Ten dogs were able to be followed at the vivaria for twelve to thirty-six months and then studied. All nipple valves remained intact, viable, and nonrefluxing without revision. All kidneys remained histologically normal except those in dogs with dilated ureters secondary to ureteroileal stenosis with concurrent calculi formation. Calculi formed on exposed metal staples and Marlex. The absorbable staples were found to promote appropriate healing and were never the nidus for stone formation. It appears that the intussuscepted nipple valve (with its mesentery removed) is reproducible and functionally reliable in preventing reflux. It also appears these valves can histologically preserve diverted kidneys if the upper urinary tract drainage is normal and calculi are minimized. The proper placement of staples and the elimination of Marlex-anchoring collars are indicated to minimize calculi.

A modified procedure for construction of a Kock continent ileal urinary reservoir: Nonafferent limb procedure

A modified technique for the construction of a Kock continent ileal urinary reservoir (Koch pouch) is reported. Our procedure avoids the afferent limb mechanism by direct uretero-pouch anastomosis using the Le Duc-Camey procedure; the nipple valve of the efferent limb is fixed directly to the pouch wall by the King procedure. This modified procedure was used in five patients with invasive bladder cancer, and the postoperative condition of the urinary tracts were periodically evaluated by image diagnostic techniques. Neither hydronephrosis nor hydroureter was observed during the study period. Pouchography and pouchometry were done in all cases studied; no pouch-ureteral reflux was observed, and both day-and night-time continence were maintained in all cases. No patient has thus far had problems with selfcatheterization. This modified technique could be a promising operative approach for the construction of a continent ileal urinary reservoir.

Clinical evaluation on Le Duc-Camey antireflux ureteroileal implantation

Le Duc-Camey antireflux ureteroileal implantation was evaluated clinically; by applying to various types of urinary reconstruction utilizing the ileum. Nineteen ureters in 10 cases including five Kock continent ileal urinary reservoirs (Kock pouches); five ileal conduit urinary diversions and one Goodwin ileocystoplasty were performed from March 1987 to August 1988. Male and female ratio was 8 to 2 and the average age was 61.7 years old. The post operative observation period was 13.9 months on the average. The outline of the operative procedure was as follows: a 3 cm sulcus was created in the mucosa along the long axis of the ileum; the ureter was passed from the serosal surface to the luminal surface and the adventitia of the ureter and the mucosa were sutured at three points in each side using 3-0 absorbable ligature to implant the ureter in the mucosal sulcus. The ureteral end was spatulated 3 mm in the upper wall and it was fixed to the mucosa by three stitches. A ureteral stent catheter, 7-8 Fr. in diameter, was indwelled in the ureter. Additional stitches were placed to strengthen the fixation on the outside surface of Kock pouches or a Goodwin ileocystoplasty. The afferent limb was not fabricated in Kock pouches because ileoureteral reflux could be prevented by the implantation technique on the pouch. Radiological evaluation was done taking IVP, loopography, pouchgraphy and cytography periodically after the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Imaging of the Kock Continent Ileal Urinary Reservoir

The Kock continent ileal urinary reservoir (Kock pouch) is a new urinary bypass system that can overcome some of the principal complications associated with other forms of urinary diversion. It is important to understand the anatomy and radiology of this new technique since radiologists play an important role in evaluating the function of the Kock pouch as well as assessing its complications. The authors review the clinical and radiographic findings in 193 patients who had undergone Kock pouch urinary diversion. Patients are evaluated radiographically in the immediate postoperative period and at regular postoperative intervals for as long as 3 years. Routine evaluation consists of Kock pouch cystography followed by intravenous urography. When indicated, computed tomography, ultrasound, and interventional radiologic procedures are used. The normal anatomy as well as the radiographic appearance of the Kock pouch is presented. In addition, the radiographic appearance of pouch complications and their frequenc...

Kock continent ileal urinary reservoir. Anatomy and potential pitfalls of radionuclide imaging.

The Kock continent ileal urinary reservoir (Kock pouch) is a new form of urinary diversion that, due to its advantages over previous techniques of urinary bypass, will probably become widespread in urologic practice. When bone imaging is performed in the presence of the Kock pouch, the unusual configuration of the pouch may obscure or simulate osseous lesions. An understanding of the surgical anatomy as well as the planar and SPECT scintigraphic appearances of the Kock pouch is necessary to avoid errors during interpretation. This series of 51 bone images reports on the variable scintigraphic appearance of the Kock pouch. In addition, the incidence and type of potentially avoidable pitfalls in the interpretation of bone imaging when this form of urinary diversion is used are evaluated.

Imaging of the Kock continent ileal urinary reservoir.

The Kock continent ileal urinary reservoir (Kock pouch) is a new urinary bypass system that can overcome some of the principal complications associated with other forms of urinary diversion. It is important to understand the anatomy and radiology of this new technique since radiologists play an important role in evaluating the function of the Kock pouch as well as assessing its complications. The authors review the clinical and radiographic findings in 193 patients who had undergone Kock pouch urinary diversion. Patients are evaluated radiographically in the immediate postoperative period and at regular postoperative intervals for as long as 3 years. Routine evaluation consists of Kock pouch cystography followed by intravenous urography. When indicated, computed tomography, ultrasound, and interventional radiologic procedures are used. The normal anatomy as well as the radiographic appearance of the Kock pouch is presented. In addition, the radiographic appearance of pouch complications and their frequency are reviewed.

Continent Ileal Urinary Reservoir (Kock Pouch)

The Kock pouch has three major limitations at the present time: The efferent nipple valve remains by far the weakest link in the procedure. A 10 to 20 per cent failure rate is too high, and it remains to be seen whether further modifications will be successful in the long run. The long-term function is unproven, and it is possible that deleterious effects may be seen as additional follow-up is obtained. Theoretically, the low-pressure system afforded by the Kock pouch may be superior in long-term safety to that provided by reservoirs made from other bowel segments. A stoma is still necessary. In spite of the above, there is a need for this type of procedure. We cannot remain content with the ileal conduit and should continue to search for better functional diversions. It is a debatable issue relative to the superiority of an internal functional reservoir to the urethra, which may lead to night-time incontinence, versus a Kock pouch with a stoma, which must be intubated. Improvement in overall survival from bladder cancer may be hard to come by, unless effective systemic chemotherapy is available; one means is to perform the surgery without delay in patients with potentially lethal cancers. To do this on a large scale, we must make the surgery as safe as possible and provide the least disruption of lifestyle. In some patients an internal intestinal reservoir attached to the urethra will be possible. Other patients may elect for a Kock pouch, whereas others may even be best served by standard ileal conduit. The growth pains of the Kock pouch have been significant but not without a reward.