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Harnableitung und Dickdarm

Das Transversumconduit und der Transversumpouch

Urinary diversion and colon

Transverse conduit and transverse pouch

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Zusammenfassung

Als inkontinenter oder kontinenter Blasenersatz wird überwiegend das terminale Ileum verwendet. Bei bestrahlten Patienten jedoch ist bei einer Harnableitung unter Verwendung von Ileumsegmenten bzw. des Ileozäkalpols mit einer erhöhten Rate an Früh- und Spätkomplikationen zu rechnen. Deswegen sollte dieses Patientenkollektiv, wenn nach pelviner Bestrahlung eine Harnableitung indiziert ist, ein Transversumconduit (TC) bzw. einen Transversumpouch als Methode der Wahl erhalten. Erfolgskonzept dieser hohen Harnableitung ist in erster Linie die Verwendung nicht bestrahlter Darm- und Harnleiteranteile. Dass die Mehrheit der Urologen wenig Erfahrung in der Dickdarmchirurgie hat, sollte, durch entsprechendes Training oder Behandlung dieses Risikopatientenkollektivs an Zentren, kompensiert werden.

Abstract

In the vast majority of cases the terminal ileum is used for incontinent or continent bladder substitution. However, in irradiated patients the use of ileum segments or the ileocecal reservoir is associated with an increased risk of early and late complications. For this reason these patients should be treated with a transverse conduit or pouch as the method of choice if urinary diversion is indicated. The superior outcome of this high urinary diversion is due to the use of non-irradiated segments of the colon and ureter. The lack of experience in large bowel surgery by today’s urologists should be compensated by training or referral of these high risk patients to a specialized center.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    S.A. Ahyai FEBU, O. Engel, F. Chun, R. Dahlem & M. Fisch

  2. Klinik für Urologie, Städtisches Klinikum Lüneburg, Lüneburg, Deutschland

    K. Sayedahmed

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  1. S.A. Ahyai FEBU
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  2. K. Sayedahmed
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  3. O. Engel
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  4. F. Chun
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  5. R. Dahlem
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  6. M. Fisch
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Correspondence to S.A. Ahyai FEBU.

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Dr. Sascha A. Ahyai und Khalid Sayedahmed waren zu gleichen Teilen an der Manuskripterstellung beteiligt.

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Ahyai, S., Sayedahmed, K., Engel, O. et al. Harnableitung und Dickdarm. Urologe 51, 937–946 (2012). https://doi.org/10.1007/s00120-012-2907-5

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  • DOI: https://doi.org/10.1007/s00120-012-2907-5

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