Clinical and functional results after continent cutaneous urinary diversion with the ileal double-T-pouch.
BACKGROUND
The aim of the study was to assess the clinical and functional results after continent cutaneous diversion with the ileal double-T-pouch.


METHODS
Between July 1998 and July 2006, 19 patients underwent continent urinary diversion with a cutaneous ileal double-T-pouch. Follow-up investigations included blood chemistry, renal ultrasound and evaluation of the outlet function. The median follow-up was 24 months (range 3-76).


RESULTS
There were no intraoperative complications and no perioperative mortality. Early postoperative complications not related to urinary diversion occurred in 6 patients (31.6%). Five patients developed complications related to the urinary diversion (26.3%). The mean operating time was 580 min (420-840). Including the patients who had good results after reoperation, 16 out of the 19 patients (84.2%) were continent day and night without any catheterization difficulties. The average pouch capacity was 490 ml (range 250-1,100). A mild acidosis was the only metabolic disorder observed. During follow-up renal function remained stable in all patients, urinary reflux, recurrent pyelonephritis or stone formation were not found. Three patients with a body mass index >30 developed a necrosis of the efferent loop resulting in pouch cutaneous fistulas.


CONCLUSIONS
Continent cutaneous urinary diversion with the ileal double-T-pouch led to good intermediate functional and clinical results. However, construction of the pouch is sophisticated, resulting in a long operation time. The double-T-pouch is not recommended in obese patients.
Seifert
Hans-Helge
HH
Department of Urology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. Hans-Helge.Seifert@usz.ch
Obaje
Alice
A
Müller-Mattheis
Volker
V
Müller
Mirko
M
Grimm
Marc-Oliver
MO
Ackermann
Rolf
R
D000138:Acidosis / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014463:Ultrasonography; D014547:Urinary Diversion / Q000295:instrumentation* / Q000379:methods*; D016476:Urinary Reservoirs, Continent; D014572:Urology / Q000295:instrumentation* / Q000379:methods*