NEW TECHNIQUES OF A CONTINENCE MECHANISM FOR MAINZ-POUCH CONTINENT CUTANEOUS URINARY-DIVERSION

In chronic animal studies, two new continence mechanisms (1. seromuscu lar-bowel-flap-tube, 2. full-thickness-bowel-flap-tube) fulfilled all requirements of a continence mechanism for continent cutaneous urinary diversion and were randomly used in Mainz-pouch-l procedures (ileocec al pouch) in 30 patients, in whom the appendix was not available or us able for construction of a continent outlet and in 3 patients with oth er forms of continent cutaneous urinary diversion (1 transverse colon pouch, 1 conversion and 1 sigmoid colon pouch). After a mean follow-up of 13 months, 18/19 patients with a seromuscular-tube (including 2 pa tients after surgical revision constructing again a submucosal seromus cular tube from another large bower segment of the same pouch) and all patients with a bowel-flap-tube are continent day and night without a leak point. 3 cases of cutaneous stoma stenosis at the umbilicus in b oth groups each were treated by dilatation or endoscopic incision. So far, both new techniques fulfill all prerequisites of a continence mec hanism for continent cutaneous urinary diversion: (1) easy catheteriza tion, (2) low complication rate, (3) uncomplicated surgical technique, (4) complete continence without a leak point and (5) universal applic ability, Long-term follow-up studies will have to further clarify adva ntages, disadvantages, and respective indications of both techniques.