[Continental cutaneous extramural ileal outlet. 20-year experience. (Multicenter study)].

Abstract

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.