Русский
Continental cutaneous extramural ileal outlet. 20-year experience. (Multicenter study)
DOI: https://dx.doi.org/10.18565/urology.2024.6.84-89
Ochcharkhadzhiev S.B., Darenkov S.P., Abol-Enein H., Shokeir A.A., Ochcharkhadzhieva A.B., Reshiev S.S., Kostoeva Z.A., Ochcharkhadzhieva M.B., Yasaev R.Sh., Nashkhoev M.R., Vashaev B.Kh., Astamirov Kh.I., Bataev M.D., Midaev M.Kh., Dzhanaraliev D.S., Amaeva Kh.Kh, Dudayeva H.H.
1) Kh.I. Ibragimov Complex Research Institute RAS, Department of Medical Research, Grozny, Russian Federation; 2) Federal State Budgetary Educational Institution of Higher Education «Grozny State Oil Technical University named after Academician M.D. Millionshchikov», Grozny, Russian Federation; 3) Academy of Sciences of the Chechen Republic. Grozny, Russian Federation; 4) Federal State Budgetary Educational Institution «Central state medical academy» of Administrative Directorate of the President of Russian Federation, Moscow, Russian Federation; 5) Air force Specialized Hospital, Cairo, Egypt; 6) Mansoura University, Urology and Nephrology Center, Mansoura, Egypt; 7) Federal State Budgetary Educational Institution of Higher Education «Chechen State University named after A.A. Kadyrov». Grozny, Russian Federation; 8) Federal State Budgetary Educational Institution of Higher Education «Ingush State University», Magas, Russian Federation; 9) Federal State Budgetary Educational Institution of Higher Education «Rostov State Medical University» of the Ministry of Health of the Russian Federation
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.
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.
Keywords: heterotopic continental urinary diversion, ileum outlet, urinary continental intestinal reservoirs
About the Autors
Corresponding author: S.B. Ochcharkhadzhiev – Doctor of Medical Sciences, Professor of FGBOU «Complex Research Institute named after Ibragimov», Department of Medical Research, Grozny, Russian Federation, e-mail: sultoch@list.ru
