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Query: UMLS:C0033377 (prolapse)
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Between March 1986 and May 1991 the Mainz pouch urinary diversion was performed in 23 patients with bladder cancer. In 12 of these 23 patients, stoma was constructed in the umbilicus. As the efferent stomal limb, the ileum was used in 10 cases and the appendix was used in 2 cases. The skin at the bottom of the umbilicus and the abdominal fascia under the umbilicus were excised round. The stomal limb was pulled through the fascial hole and the stomal margin was sutured to the skin. The cosmetic results of the umbilical stoma were satisfactory in these 12 patients. Pouch capacity ranged from 330 ml to 560 ml and good urinary continence without difficulty of self-catheterization was obtained in 11 patients. In 1 patient difficulty in catheterization occurred due to a pocket-formation in the stomal limb and the operative revision was performed. Stomal stenosis occurred in 1 patient. Acute renal failure followed by intestinal bleeding occurred in 1 patient who was cured with intensive care including hemodialysis. The results of our study show the superiority of the umbilical stoma in the Mainz pouch in regard to good cosmetic appearance, no need to use a Marlex collar, little bending of catheterization route and low incidence of complications such as parastomal hernia or nipple valve prolapse.
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PMID:[Mainz pouch with umbilical stoma]. 156 39

Urinary continence with a Kock or Mainz pouch is achieved by a nipple valve of the invaginated ileum which is usually fixed with metal staples. However, metal staples can cause various complications as a foreign body. The seromuscular stripping method, a new technique to create a nipple valve, was applied to 17 patients with bladder cancer in the construction of a continent urinary reservoir by the ileocolonic pouch (Mainz pouch). Metal staples were not used. The results were satisfactory except for 2 patients who became incontinent because of prolapse of the nipple in one and insufficient valve function due to ischemic change of the nipple valve in the other. Histology of the nipple valve from an autopsy case showed a good double layer nipple valve that functioned well to preserve continence.
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PMID:A seromuscular stripping method to create a nipple valve without metal stapling for continent urinary reservoir. 199 96

Kock continent ileal reservoir for urinary diversion was performed in 53 patients with invasive bladder cancer (52) or neurogenic bladder (1). The postoperative follow-up period was from six to thirty-nine months. The clinical results showed no metabolic disturbance of blood electrolytes or acidity. Prolapse of efferent nipple valve developed in 4 patients (7.6%); and 2 underwent revisional surgery with a good result. Another 4 patients (7.6%) suffered from poor continence and relatively frequent catheterization to empty the pouch was necessary to prevent urine leakage through the stoma. Urodynamic study of the Kock pouch in these 4 patients showed a short functional nipple valve length and small pouch capacity. The other 45 patients (84.8%) had good continence. Urodynamic study of the pouch in 20 patients showed low pressure (mean of 13.3 cm H2O) in the pouch and high pressure (mean of 72.1 cm H2O) at the efferent nipple valve. Three patients had unilateral hydronephrosis in the follow-up intravenous urography. Corrective surgery for stenosis at the right ureteroileal anastomosis was done in 1 patient with normalization of the upper urinary tract afterward. The other 2 patients were managed by close observation for the mild hydronephrosis. Symptomatic bacteriuria developed in only 3 patients (5.7%) and responded well to antibiotic management. Reservoirography demonstrated no reflux into the upper urinary tract in all the follow-up patients. There was no significant change of the renal function at twenty-four months after operation detected by radionuclide (131I-Hippuran) renal functional study. All patients were satisfied with Kock urinary diversion.
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PMID:Clinical experience of Kock pouch continent urinary diversion. 232 24

Internal urinary reservoir type urinary diversions have been getting popularity since Kock reported a continent ileal reservoir in 1982. From November 1984 through October 1987, we performed Kock pouch operation in 75 patients (male 64, female 11; from 24 to 82 years old, mean age 56 years old). The underlined diseases were mostly bladder cancer patients; bladder cancer 70, rectal cancer 2, prostatic sarcoma 1, vesical exstrophy 1 and neurogenic bladder 1 case. The end results for 71 evaluable cases, followed up more than 3 months, were excellent in 49 (69%), good 14 (20%), fair 6 (8.5%) and poor 2 (2.8%), with success rate 89%. The most common complication was the nipple malfunction; prolapse, including intermittent prolapse, in 7 patients, slippage or sliding in 1, and eversion in one patient. Stone formation occurred in 6 patients, mild acidosis in 2 and a entero-pouch fistula in a patient who was re-diverted from a ileal conduit. There were 2 deaths postoperatively. Late complications were prominently decreased due to several important modifications of the operative technique, such as usage of Cavitron Ultrasonic Surgical Aspirator (CUSA) for defatting the mesentery, and fixing the nipple to the pouch. In conclusion, Kock pouch can be a safe and sound operative modality for patients who need urinary bladder replacement.
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PMID:[Urinary diversion with Kock pouch: clinical results in 75 cases focusing on late complications]. 317 39

We tried the new method of urinary diversion via a continent ileal reservoir, reported by Kock in 1982, and now being accepted with great enthusiasm and satisfaction not only by doctors, but also by patients in Europe and in the United States. With this method, continency with storage of urine under low pressure is well maintained so that no external appliances are necessary. Ileorenal reflux is also prevented with this nipple valve forming technique, minimizing impairment of renal function. We report for the first time in Japan 13 cases, in which this method of innovative urinary diversion was used, with special attention paid to its demanding surgical technique and early results with its complications. From November, 1984 to August, 1985, we performed urinary diversion via the Kock pouch in 13 cases: 10 males and 3 females, from 35 to 67 years old (mean age 49 years), 11 bladder cancer patients, and 2 rectal cancer patients. The 2 patients with rectal cancer died from cancer and 1 bladder cancer patient with psychosis died from mental crisis 4 months after the operation. Of the 10 cases followed up long enough, 7 cases were in excellent condition with complete continence, 2 cases were in good condition with minor leak due to intermittent prolapse of the nipple valve, and in one case with failure, due to the postoperative ileus and eversion of the nipple valve, which made it difficult to catheterize into the pouch. Excision of the pouch and conversion to the standard ileal conduit was performed by reoperation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Urinary diversion with the Kock continent ileal reservoir: report of 13 cases]. 391 15

Kock continent ileal reservoir has been one of the major options of urinary diversion for the patients with bladder cancer. We performed Kock pouch operation in 16 patients (male 12, female 4; from 41 to 66 years old, mean age 57 years old). Since the reservoir function of Kock pouch after a long postoperative period is not well known, we examined the volume capacity, the compliance and the length of efferent valve of Kock pouch in 8 patients during a 3-year postoperative period. Although the compliance was stable, the volume capacity and the length of the efferent valve showed a decreasing tendency. The shorter efferent valve was not always associated with the case of urinary incontinence. Most of the complications in 15 patients was trouble of efferent valve (prolapse of efferent valve in 7 cases and eversion or fistula formation that required reconstruction surgery in 3 cases). Although some complications were observed, the reservoir function of the pouch was stable. Therefore this method is reliable for permanent urinary diversion.
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PMID:[A study on reservoir function of Kock pouch during a 3-year postoperative period]. 812 18

In women undergoing radical cystectomy for bladder cancer, orthotopic bladder reconstruction is now a viable alternative to urinary diversion: preservation of the external urethral sphincter by sectioning the urethra 0.5-1 cm distally to the bladder neck allows maintenance of urinary continence without compromising cancer control. 12 cases of bladder reconstruction in women operated on from 1986 to 1995 are presented here. A personal technique for the creation of an ileal neobladder is described: the use of staplers for detubularization of the ileum significantly reduces the operating time ("simplified ileal bladder"). Other important points of technique are as follows: 1. Careful preparation of the bladder neck and proximal urethra, staying above the pubo-urethral ligaments that must be preserved as the distal landmark of dissection; 2. "Nerve-sparing" isolation of the posterolateral wall of the bladder from the vagina; 3. Careful positioning of the pouch in the true pelvis, in order to avoid posterior prolapse of the neobladder. So far, results of bladder reconstruction in this series of patients are encouraging, both from a functional and oncological standpoint.
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PMID:[Orthotopic neobladder in women]. 920 14

Female incontinence and pelvic organ prolapse have been defined as contraindications to orthotopic bladder substitution. A 75-old-year woman with slight stress incontinence, Stage III cystocele, and vaginal vault prolapse after subtotal hysterectomy underwent radical cystectomy for Stage T2 bladder cancer. After radical cystectomy, pelvic floor integrity was restored by colposacropexy with a rectangular polypropylene mesh and an ileal reservoir to urethra was constructed. After 1 year of follow-up, she had complete daytime continence and only needed to wear a pad during the night. Her postvoid residual urine volume was constantly less than 100 mL.
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PMID:Pelvic floor reconstruction before orthotopic bladder replacement after radical cystectomy for bladder cancer. 1566 93

Prostate cancer, bladder cancer, and pelvic floor weakness are among the most common diseases of the pelvis. Cardinal symptoms include painless macrohematuria in bladder cancer and urinary and fecal incontinence in pelvic floor weakness. Suspicion of prostate cancer currently is most frequently raised when the serum concentration of prostate-specific antigen is pathologically elevated. Besides extensive clinical and invasive diagnosis, clinical imaging is frequently applied for the localization, locoregional staging, and diagnosis of recurrence of prostate cancer and invasive bladder cancer, and in clinically difficult cases of cystocele, enterocele, rectocele, descensus or prolapse of vagina, uterus, and rectum, and rectal intussusception. Magnetic resonance imaging with T2-weighted TSE or FSE images in several planes combined with either axial, T1-weighted images and MR spectroscopy for the prostate, dynamic contrast-enhanced T1-weighted images for the urinary bladder, or dynamic T2-weighted functional images for pelvic floor incontinence are particularly well suited as clinical imaging methods.
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PMID:[Diagnostic radiology of the pelvis. Prostate cancer, bladder cancer, and incontinence]. 1839 94

The modern-day urologist is continually armed with new instruments and technology aimed at decreasing the overall invasiveness of urologic procedures. Robotic technology is aimed at improving clinical outcomes by correcting human technical inadequacies such as hand tremors and imprecise suturing. The first reported use of robotics to assist with surgery was in 1985, and the first use of robotics in urology was published in 1989. The currently utilized master-slave system (da Vinci Robotic Platform), Intuitive Surgical, Sunnyvale, CA) has popularized robotic surgery for use in numerous urologic conditions including prostate cancer, bladder cancer, renal cancer, uretero-pelvic junction obstruction, and pelvic prolapse. New developments in robotic technology may revolutionize many other aspects of urology including percutaneous renal access and rounding on patients after surgery. This review provides a brief overview of the history of robotics in urology, a description of the da Vinci surgical system and its current utilization as well as limitations, and a review of evolving robotic technology in the field of urology.
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PMID:Robotics in urology: past, present, and future. 1841 24


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