title: Long-term follow-up of submucosal tunnel and serosa-lined extramural tunnel ureter implantation in ileocaecal continent cutaneous urinary diversion (Mainz pouch I).
abstract: OBJECTIVE
  To assess upper urinary tract complications and renal function in patients with a submucosal tunnel and serosa-lined extramural tunnel ureter implantation during the long-term follow-up of ileocaecal continent cutaneous urinary diversion (Mainz pouch I).
  
  
  METHODS
  In all, 458 patients who had diversion with the ileocaecal pouch were analysed in a retrospective follow-up study. Uretero-intestinal implantation was done using a submucosal tunnel (ST) in 809 reno-ureteric units (RUs) and by the serosa-lined extramural tunnel (ET) technique in 74 RUs. The median age of the patients at the time of surgery was 47.1 years, and the median follow-up was 89.0 months.
  
  
  RESULTS
  For the ST, there was anastomotic obstruction in 59 RUs (7.3%) at a median of 16.8 months after diversion; the obstruction-free intervals at 1, 5 and 10 years were 97%, 93% and 91%, respectively. Obstruction rates were 13.9% for previously dilated upper tracts and 17.1% in patients with a neurogenic bladder. Serum creatinine levels were < or =1.6 mg/dL in 97% of the patients at the latest follow-up. For ET, there was anastomotic obstruction in three RUs (4.1%) at a median of 17.2 months after diversion. Obstruction-free intervals at 1, 5 and 10 years were 100%, 96% and 96%. Preoperative dilation of the upper tracts did not reduce the obstruction rate (3.1%), but it was 7.1% in patients with a neurogenic bladder. Serum creatinine levels were < or =1.6 mg/dL in 98% of the patients at the latest follow-up.
  
  
  CONCLUSIONS
  The ET gives lower obstruction rates than the ST, especially when upper tracts are dilated and in patients with a neurogenic bladder. Renal function remained stable with both techniques in the long term.
authors.affiliation: Department of Urology, Johannes Gutenberg-University, School of Medicine, Mainz, Germany. christophws@aol.com
authors.forename: Christoph
authors.initials: C
authors.lastname: Wiesner
authors.forename: Sascha
authors.initials: S
authors.lastname: Pahernik
authors.forename: Raimund
authors.initials: R
authors.lastname: Stein
authors.forename: Katja
authors.initials: K
authors.lastname: Hähn
authors.forename: Ludger
authors.initials: L
authors.lastname: Franzaring
authors.forename: Sebastian W
authors.initials: SW
authors.lastname: Melchior
authors.forename: Joachim W
authors.initials: JW
authors.lastname: Thüroff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D001745:Urinary Bladder Diseases / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent