Evoluting the invaginated--one step closer to the perfect valve? Modified serosal lined tapered ileum (Kälble's procedure) as a continence mechanism for catheterizable pouches.
BACKGROUND
A sufficient and easily catheterizable continence mechanism is essential in continent cutaneous pouches. Kälble embedded a tapered ileum as efferent segment into a serosal lined tunnel formed by an ileal 'U' according to the principle of Abol-Enein and Ghoneim. We report a modified technique applied in a series of 12 patients who had undergone different urinary diversions.


METHODS
All patients received a modified Kälble procedure (first-line urinary diversion, n = 8; revision/undiversion, n = 4) for different forms of continent pouches. To alleviate embedding of the efferent segment, ileal detubularization was performed asymmetrically. Mean follow-up was 9.5 months.


RESULTS
All patients were continent and performed self-catheterization easily. Of 12 patients, 2 underwent endoscopic incision for stomal stenosis 8 and 12 months postoperatively.


CONCLUSIONS
Subject to our short follow-up, Kälble's technique is a promising alternative in patients undergoing a continent cutaneous urinary diversion but offers an inapplicable or missing appendix.
Department of Urology, University of Bonn, Sigmund-Freud-Strasse 25, Bonn, Germany. Guido.Fechner@ukb.uni-bonn.de
Guido
G
Fechner
Sebastian
S
Rogenhofer
Stefan
S
Hauser
Stefan C
SC
Müller
D000293:Adolescent; D000368:Aged; D001065:Appendix / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013536:Suture Techniques; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014546:Urinary Catheterization / Q000379:methods; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000517:prevention & control; D016476:Urinary Reservoirs, Continent; D013520:Urologic Surgical Procedures / Q000379:methods*