Continental cutaneous extramural ileal outlet. 20-year experience (multicenter study)

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Purpose. Analysis of the results of the formation of extramural retaining catheterization cutaneous stomas (outlets) during the implementation of heterotopic reservoirs from the ileum in the long-term period.

Materials and methods. From 2001 to 2024, the formation of a heterotopic reservoir from the ileum according to Abol-Enein was performed in 161 patients (103 men, 42 women and 16 children). Primary urine diversion was performed in 138 patients, conversion – in 23. The technique consisted of creating a detubularized W-shaped ileal reservoir with the formation of an outlet and ureteral transplantation (inlet) using the extramural technique. A longitudinally narrowed segment of the ileum was used as a continental outlet.

Results. A total of 157 patients (97.5%) were dry both day and night. In 4 patients (2.5%), in the early years of mastering the surgical technique, failure of the urinary continence mechanism was observed: two of them underwent open revision and outlet reconstruction, the remaining patients preferred a permanent catheter. Two patients (1.2%) had stoma stenosis: in 1 of these cases, Y-shaped plastic surgery with a skin flap was successfully performed; bougienage of the external part of the outlet was effective in another one.

In two patients (1.2%) with an extramural outlet, reservoir retention and the impossibility of catheterization were observed. Percutaneous drainage under ultrasound control became a solution to the problem and free catheterization became possible later.

The difficulty in passing a catheter through the outlet was detected in 3 patients (1.9%), they also refused reconstructive intervention in favor of a permanent catheter for various reasons. It has been established that the cause of difficult catheterization is an outlet angulation and/or reservoir ptosis. The angulation can be prevented by using an adequate outlet length and proper reservoir fixation.

Conclusions. The extramural outlet according to Abol-Enein provides high efficiency of the heterotopic reservoir and satisfactory quality of life for patients in the near and distant periods, for both primary and conversion urine diversions.

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Sobre autores

S. Ochcharkhadzhiev

Kh.I. Ibragimov Complex Research Institute RAS; Federal State Budgetary Educational Institution of Higher Education «Grozny State Oil Technical University named after Academician M.D. Millionshchikov»; Academy of Sciences of the Chechen Republic

Autor responsável pela correspondência
Email: sultoch@list.ru

Doctor of Medical Sciences, Professor, chief researcher, Department of Medical Research, Medical center, Urology clinic

Rússia, Grozny; Grozny; Grozny

S. Darenkov

Federal State Budgetary Educational Institution «Central state medical academy» of Administrative Directorate of the President of Russian Federation

Email: darenkov@list.ru

Doctor of Medical Sciences, Professor

Rússia, Moscow

H. Abol-Enein

Air force Specialized Hospital; Kh.I. Ibragimov Complex Research Institute RAS

Email: hassanabolenein@hotmail.com

Doctor of Medical Sciences, Professor, chief researcher, Department of Medical Research

Egito, Cairo; Grozny, Russian Federation

A. Shokeir

Mansoura University, Urology and Nephrology Center; Kh.I. Ibragimov Complex Research Institute RAS

Email: shokeir@hotmail.com

Doctor of Medical Sciences, Professor, chief researcher, Department of Medical Research

Egito, Mansoura; Grozny, Russian Federation

A. Ochcharkhadzhieva

Kh.I. Ibragimov Complex Research Institute RAS; Federal State Budgetary Educational Institution of Higher Education «Grozny State Oil Technical University named after Academician M.D. Millionshchikov»

Email: Ocharova1982@list.ru

senior researcher of Kh.I. Ibragimov Complex Research Institute RAS, Department of Medical Research, Medical center, Urology clinic

Rússia, Grozny; Grozny

S. Reshiev

Kh.I. Ibragimov Complex Research Institute RAS; Federal State Budgetary Educational Institution of Higher Education «Chechen State University named after A.A. Kadyrov»

Email: ssreshiev@mail.ru

Doctor of Economic Sciences Professor, chief researcher, Department of Medical Research

Rússia, Grozny; Grozny

Z. Kostoeva

Kh.I. Ibragimov Complex Research Institute RAS; Federal State Budgetary Educational Institution of Higher Education «Ingush State University»

Email: kostoeva.zareta@yandex.ru

Doctor of Medical Sciences, Professor, chief researcher, Department of Medical Research

Rússia, Grozny; Magas

M. Ochcharkhadzhieva

Kh.I. Ibragimov Complex Research Institute RAS

Email: och_makka@mail.ru

senior researcher, Department of Medical Research

Rússia, Grozny

R. Yasaev

Kh.I. Ibragimov Complex Research Institute RAS
Federal State Budgetary Educational Institution of Higher Education «Rostov State Medical University» of the Ministry of Health of the Russian Federation

Email: yasaev.ruslan@gmail.com

researcher, Department of Medical Research

Rússia, Grozny; Rostov-on-Don

M. Nashkhoev

Kh.I. Ibragimov Complex Research Institute RAS

Email: magomednashkhoev@gmail.com

Candidate of Medical Sciences, leading researcher, Department of Medical Research

Rússia, Grozny

B. Vashaev

Kh.I. Ibragimov Complex Research Institute RAS

Email: sultoch@list.ru

researcher, Department of Medical Research

Rússia, Grozny

Kh. Astamirov

Kh.I. Ibragimov Complex Research Institute RAS

Email: T.khuseyn@gmail.com

laboratory assistant, Department of Medical Research

Rússia, Grozny

M. Bataev

Kh.I. Ibragimov Complex Research Institute RAS

Email: sultoch@list.ru

junior researcher, Department of Medical Research

Rússia, Grozny

M. Midaev

Kh.I. Ibragimov Complex Research Institute RAS

Email: sultoch@list.ru

research engineer, Department of Medical Research

Rússia, Grozny

D. Dzhanaraliev

Kh.I. Ibragimov Complex Research Institute RAS

Email: djanaraliev_95@mail.ru

research engineer, Department of Medical Research

Rússia, Grozny

Kh. Amaeva

Kh.I. Ibragimov Complex Research Institute RAS

Email: amaevahaipat@gmail.com

senior laboratory assistant, Department of Medical Research

Rússia, Grozny

H. Dudayeva

Kh.I. Ibragimov Complex Research Institute RAS

Email: heda.dudaeva.95@mail.ru

senior laboratory assistant, Department of Medical Research

Rússia, Grozny

Bibliografia

  1. Leibovitch I., Avigad I., Nativ O., Goldwasser B. The frequency of histopathological abnormalities in incidental appendectomy in urological patients: the implications for incor-poration of the appendix in urinary tract reconstruction. J Urol. 1992;148:41.
  2. Reidmiller H., Burger R., Muller S., Thuroff J., Hohenfellner R. Continent appendix stoma: a modification of the Mainz pouch technique. J Urol. 1990;143:1115.
  3. Abol-Enein H., Ghoneim M.A. Serous-lined extramural ileal valve: a new continent urinary outlet. J Urol. 1999;161:786.
  4. Continent cutaneous ileal pouch using the serous lined extramural valves. The Mansoura experience in more than 100 patients. J Urol. 2004;172(2):588–91.
  5. Stein J.P., Skinner D.G. T-mechanism applied to urinary diversion: the orthotopic T-pouch ileal neobladder and cutaneous double-T-pouch ileal reservoir. Tech Urol. 2001;7(3):209-22. PMID: 11575518.
  6. Ochcharhadzhiev S.B., Ochcharhadzhieva A.B., Kirpatovsky V.I. Prevention of difficulties of self-catheterization in patients after heterotopic intestinal bladder replacement. Military Medical Journal. 2008;6:65. Russian (Оччархаджиев С.Б., Оччархаджиева А.Б., Кирпатовский В.И. Предотвращение трудностей самокатетеризации у больных после гетеротопического кишечного замещения мочевого пузыря. Военно-медицинский журнал. 2008;6:65).

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2. Fig. 1. Stages of formation of extramural inlet and outlet A — a segment of the ileum is laid in a W-shape and the posterior wall of the reservoir is formed, two additional segments are truncated and sutured to form an outlet and inlet. (B) — the grooves of the outlet and inlet are formed by suturing the walls of the intestine

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3. Fig. 2. Three-dimensional computer processing of the image of the ileum outlet and reservoir. The arrow indicates an elongated outlet and ptosis of the reservoir in a patient with catheterization problems.

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4. Fig. 3. Patient I., 44 years old. Retrograde (ascending) reservoirogram. Elongation, angulation of the outlet due to gradually developing ptosis of the reservoir, which caused difficult catheterization; the retaining function is fully consistent. Reservoir-ureter-renal reflux (inlet according to Nesbit)

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5. Fig. 4. Reservoirogram: consistency of the outlet retention function, absence of reflux, adequate reservoir capacity

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