title: Colon pouch (Mainz pouch III) for continent urinary diversion after pelvic irradiation.
abstract: OBJECTIVE
  Urinary diversion after previous pelvic irradiation is challenging. The use of irradiated bowel in particular is associated with an increased rate of early and late complications. We therefore performed continent cutaneous urinary diversion using exclusively nonirradiated bowel segments in this group of patients.
  
  
  METHODS
  A continent colon pouch for urinary diversion was performed in 44 female patients after pelvic irradiation. The indications were irreparable vesical fistula in 20, local recurrence of gynecologic tumors in 22, and radical cystectomy for bladder cancer in 2 patients. Depending on the length of the nonirradiated bowel segment, a transverse-ascending colon pouch (n = 8) or transverse-descending colon pouch (n = 36) was performed. The efferent segment was created from a tapered bowel segment embedded in the pouch wall. The ureters were implanted using a submucosal (n = 67) or subserosal (n = 17) extramural tunnel.
  
  
  RESULTS
  No pouch-related complications were observed during the immediate postoperative period. In long-term follow-up (mean 52.2 months), upper urinary tract dilation was seen in five renal units. All five of these had been dilated preoperatively, and none required ureteral reimplantation. Incontinence occurred in 2 patients; both underwent reoperation with subsequent continence. Umbilical stoma stenosis was observed in 6 patients.
  
  
  CONCLUSIONS
  The technique of the colon pouch for continent urinary diversion in previously irradiated patients is safe and has a low complication rate. The use of nonirradiated bowel segments should be the method of choice in this group of patients.
authors.affiliation: Department of Urology, Johannes Gutenberg University, Mainz, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Leissner
authors.forename: P
authors.initials: P
authors.lastname: Black
authors.forename: M
authors.initials: M
authors.lastname: Fisch
authors.forename: M
authors.initials: M
authors.lastname: Höckel
authors.forename: R
authors.initials: R
authors.lastname: Hohenfellner
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002988:Cloaca / Q000601:surgery; D003106:Colon / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011832:Radiation Injuries / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery; D001747:Urinary Bladder Fistula / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy; D014719:Vesicovaginal Fistula / Q000601:surgery