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Urology. 2012 Apr;79(4):943-9. doi: 10.1016/j.urology.2011.12.026.

Preliminary short-term outcomes of a modified double-T ileal continent cutaneous urinary diversion using Yang-Monti tube implantation through serosa-lined extramural tunnel: the PGIMER pouch.

Author information

1
Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. drmayank.22@gmail.com

Abstract

OBJECTIVE:

To present our simplified technical modification of double-T continent cutaneous diversion (CCD) using Yang-Monti tubes.

METHODS:

During 2008-2011, 8 adult patients underwent CCD; 4 had classical exstrophy, 2 bladder cancer, 1 recurrent vaginal cancer post-radiotherapy, and 1 prostate cancer with post-simple retropubic prostatectomy urethral stricture with incontinence. For reconstruction, a 45- to 50-cm segment of terminal ileum sparing 25 cm of terminal ileum was harvested. Its distal 3- to 6-cm and proximal 3-cm segments were separated on vascular pedicle and fashioned into Yang-Monti tubes (1 proximally and 1 or 2 distally). The middle 40- to 45-cm detubularized segment was fashioned into a "W" shape, and serosal aspects of adjacent loops were sutured together close to the mesentery. The tubes were implanted into the W pouch via extramural serosa-lined tunnel (Abol-Enein and Ghoneim). The pouch was closed transversely over an 18-Fr pouchostomy and 16-Fr stomal catheter. The ureters were implanted into the proximal tube using the Wallace principle, over 6- to 8-Fr infant feeding tubes exteriorized through the pouch. The distal end of the distal tube was made into a flush stoma.

RESULTS:

In the early postoperative period, intestinal obstruction (2 cases), ureteroileal anastomotic leakage (3 cases) and vesico-ileocutaneous fistula (1 case) were encountered. No ureteroileal anastomotic obstruction or catherization-related difficulty was observed until the last follow-up (2 months to 3 years). Of 15 anastomoses, 14 were nonrefluxing.

CONCLUSION:

Ileal double-T CCD using the Yang-Monti principle is technically feasible and relatively simple, particularly in nonirradiated ileum. However, early complications indicate a learning curve, and long-term follow-up and larger data are needed.

PMID:
22469584
DOI:
10.1016/j.urology.2011.12.026
[Indexed for MEDLINE]

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