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Katheterisierbarer Kontinenzmechanismus für verschiedene Harnableitungsreservoire

Getapertes, seroserös eingebettetes Ileum

Catheterizable continence mechanisms for various urinary diversion reservoirs

Serosa lined and tapered ileum

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Zusammenfassung

In einer retrospektiven Multicenterstudie an vier Kliniken wurden die perioperativen Komplikationen sowie Inkontinenz- und Stomastenoseraten von getapertem, seroserös eingebettetem Ileum als katheterisierbarer Kontinenzmechanismus für verschiedene Harnableitungsreservoire erfasst. Zwischen 2008 und 2012 erhielten 40 Patienten ein solches katheterisierbares Stoma, 15 (37,5%) davon als kontinente Vesikostomie mit Blasenhalsverschluss wegen postoperativer Inkontinenz/Rezidivblasenhalsenge (radikale Prostatektomie, TUR-Prostata, Blasenhalsinzision, n=11), neurogener Blasenentleerungsstörung mit reduzierter Blasenkapazität und Inkontinenz (n=2), reduzierter Blasenkapazität bei interstitieller Zystitis (n=1) und urethralem Tumorrezidiv nach Ileumneoblase (n=1). Bei 25 (62,5%) Patienten wurde der Kontinenzmechanismus bei einem modifizierten Mainz-Pouch I angelegt, davon in 19 Fällen primär und bei 6 Patienten sekundär als „trouble shooting“. Komplikationen wurden entsprechend der Clavien-Klassifikation beurteilt. Insgesamt konnten 29 Patienten hinsichtlich der Kontinenz bzw. Stenosebildung postoperativ nachuntersucht werden, die mediane Nachbeobachtungszeit betrug 25 (1–111) Monate. Bei 1 von 11 Patienten mit kontinenter Vesikostomie trat eine Inkontinenz auf (9,1%), bei 2 von 11 Patienten eine Stenose (18,2%). Bei 18 Patienten mit Ileozäkalpouch lag die Inkontinenzrate bei 0%, die Stenoserate bei 11,1% (2/18). Die vorgestellte Technik stellt ein zuverlässiges und komplikationsarmes Verfahren einer katheterisierbaren kontinenten Harnableitung dar, die primär und sekundär angewandt werden kann.

Abstract

In a retrospective multicenter study of four clinics perioperative complications as well as incontinence and stoma stenosis of serosa-lined tapered ileum as catheterizable continence mechanisms for different urinary diversions were analyzed. Between 2008 and 2012 a total of 40 patients received a continent catheterizablestoma, 15 (37.5%) in combination with continent vesicostomy and closure of the bladder neck due to postoperative incontinence and recurrent stenosis including radical prostatectomy, transurethral resection (TUR) of the prostate, bladder neck incision (n=11), neurogenic bladder with reduced capacity and incontinence (n=2), interstitial cystitis (n=1) and recurrent urethral tumor following ileal neobladder (n=1). Of the patients 25 (62.5%) received this continence mechanism in combination with a modified Mainz pouch I, in 19 patients as primary and in 6 patients as secondary efferent segment for trouble shooting. The complications were subdivided according the Clavien classification. In 29 patients information concerning continence and stenosis were obtained, the median follow-up was 25 months (range 1-111 months). In patients with continent vesicostomy (n=11) the incontinence rate was 9.1% (1/11) and the stenosis rate 18.2% (2/11). In 18 patients with an ileocecal pouch, incontinence and stenosis rates were 0% and 11.1% (2/18), respectively. The presented technique is a safe continence mechanism for various catheterizable continent urinary diversions for both primary and secondary indications.

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Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, St. Antonius-Hospital, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland

    P. Anheuser, J. Kranz & J. Steffens

  2. Klinik für Urologie und Kinderurologie, Klinikum Fulda, Fulda, Deutschland

    S. Rausch & T. Kälble

  3. Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Bonn, Deutschland

    G. Fechner & S.C. Müller

  4. Klinik für Urologie, Heilig-Geist-Krankenhaus Köln, Köln, Deutschland

    M. Braun

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  1. P. Anheuser
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  2. J. Kranz
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  3. S. Rausch
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  4. G. Fechner
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  6. M. Braun
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  7. J. Steffens
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  8. T. Kälble
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Correspondence to P. Anheuser.

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Anheuser, P., Kranz, J., Rausch, S. et al. Katheterisierbarer Kontinenzmechanismus für verschiedene Harnableitungsreservoire. Urologe 51, 947–955 (2012). https://doi.org/10.1007/s00120-012-2908-4

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  • DOI: https://doi.org/10.1007/s00120-012-2908-4

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