New Techniques of a Continence Mechanism for Mainz-Pouch Continent Cutaneous Urinary Diversion

Summary:

In chronic animal studies, two new continence mechanisms (1. seromuscular-bowel-flap-tube, 2. full-thickness-bowel-flap-tube) fulfilled all requirements of a continence mechanism for continent cutaneous urinary diversion and were randomly used in Mainz-pouch-1 procedures (ileocecal pouch) in 30 patients, in whom the appendix was not available or usable for construction of a continent outlet and in 3 patients with other forms of continent cutaneous urinary diversion (1 transverse colon pouch, 1 conversion and 1 sigmoid colon pouch). After a mean follow-up of 13 months, 18/19 patients with a seromuscular-tube (including 2 patients after surgical revision constructing again a submucosal seromuscular tube from another large bowel segment of the same pouch) and all patients with a bowel-flap-tube are continent day and night without a leak point. 3 cases of cutaneous stoma stenosis at the umbilicus in both groups each were treated by dilatation or endoscopic incision. So far, both new techniques fulfill all prerequisites of a continence mechanism for continent cutaneous urinary diversion: (1) easy catheterization, (2) low complication rate, (3) uncomplicated surgical technique, (4) complete continence without a leak point and (5) universal applicability. Long-term follow-up studies will have to further clarify advantages, disadvantages, and respective indications of both techniques.

Key words:

Continent cutaneous urinary diversion - Continence mechanism - Mainz-pouch-1