ILEAL T-POUCH AS A BAILOUT OPTION FOR CONTINENT CUTANEOUS URINARY
DIVERSION IN ADULTS WHEN THE RIGHT COLON IS UNAVAILABLE
Darshan Patel, B.S., Will Brant, M.D., Jim Hotaling, M.D., M.S., Jeremy Myers, M.D. University of Utah Division of Urology, Salt Lake City, UT
•The right colon pouch reservoir is known for its reliability in patients desiring a continent catheterizable pouch; however, the right colon may not be available or viable for use in reservoir formation.
•We describe our experience with the use of an ileal T- pouch in two cases as a bailout option in continent cutaneous urinary diversion in adults.
•Patient 1: A 64-year-old female with history of endometrial cancer s/p hysterectomy and vaginectomy and colon cancer s/p right colectomy who developed vesicovaginal fistula and urinary incontinence. She previously had 2 slings placed that failed and opted for urinary diversion given her devastated bladder outlet. Her history of a right colectomy eliminated the possibility of a right colon reservoir.
•Patient 2: A 69-year-old female with history of endometrial cancer s/p hysterectomy and adjuvant radiotherapy. She developed a vesicovaginal fistula, which did not improve with hyperbaric oxygen therapy, and had total urinary incontinence with pubovaginal sling placement at the time of her hysterectomy. She elected for continent diversion. Intra-operatively, her terminal ileum was adhesed in the pelvis due to the extent of radiation injury and was unusable for reservoir formation.
•In these 2 patients, the ileal T-pouch serosal lined extramural channel was created as the continence mechanism and the efferent limb for catheterization from the abdominal wall.
•The ureters were implanted into the pouch as a nipple valve in 1 patient to prevent reflux and in a refluxing open anastomosis in another due to concern of radiation injury.
•Both patients are catheterizing well without significant leak from the channel beyond a small amount immediately after catheterization.
•There have been no issues with catheterization or stenosis.
•The patient with radiation injury has developed high-grade stenosis of her right ureter, related to her pelvic radiation. "
•Our short-term experience demonstrates acceptable outcomes for ileal T- pouch for a continent catheterizable pouch as an alternative to right colon pouch.
•Surgeons that routinely perform continent catheterizable pouch creation should have some alternative to the right colon if it is not viable or absent.