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Santosh PGI pouch: A new innovation in urinary diversion.

Kumar S, Devana SK, Sharma AP, Singh SK - Cent European J Urol (2015)

Bottom Line: No significant complications were noted in the pouch reconstruction.No ureteroileal anastomotic stricture or difficulty in catheterizing the pouch was seen.The Santosh PGI pouch, which is a type of CCD, is technically feasible, easy to reconstruct with acceptable continence and offers minimal morbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

ABSTRACT

Introduction: To know the feasibility and outcome of the Santosh PGI pouch as a new innovative technique of continent cutaneous diversion (CCD) following cystectomy.

Material and methods: Twelve patients (eleven with carcinoma of the bladder and one with an exstrophy of the bladder) underwent CCD using the Santosh PGI pouch after cystectomy. A 50-cm segment of terminal ileum was isolated 15-20 cm proximal to the ileocecal junction. The ileal segment was folded into the form of an 'S' configuration. On the antimesenteric border three longitudinal incisions were performed of about 7 cm in length. The terminal 8 cm portion of the distal part of the pouch was used for creating the intussuscepted nipple valve. Demucosalization of the interior of the nipple, fixing the nipple valve with the serosa of the pouch wall and wrapping of the catheterizable channel with a pouch wall for providing continence was done. The uretero-pouch anastomosis was done using the serosal lined tunnel technique. The catheterizable channel was brought out through the right rectus muscle.

Results: Median follow-up of the patients was 13.5 months. No significant complications were noted in the pouch reconstruction. Duration of the pouch reconstruction was around 75-110 min. Postoperatively, one patient had a UTI and another had paralytic ileus on the follow-up. All patients were doing regular CIC with acceptable continence of up to 400 ml. No ureteroileal anastomotic stricture or difficulty in catheterizing the pouch was seen.

Conclusions: The Santosh PGI pouch, which is a type of CCD, is technically feasible, easy to reconstruct with acceptable continence and offers minimal morbidity.

No MeSH data available.


Related in: MedlinePlus

The completed Santosh PGI pouch with catheters and splints insitu and its pictoral depiction.
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Figure 0011: The completed Santosh PGI pouch with catheters and splints insitu and its pictoral depiction.

Mentions: Midline infraumbilical incision was performed. Initially, radical cystoprostatectomy was done. After removal of the specimen, bilateral standard pelvic lymph node dissection was completed. The patient with exstrophy of the bladder underwent cystectomy only. A piece of 50-cm segment of the terminal ileum was isolated 15-20 cm proximal to the ileocecal junction (Figure 1A). Restoration of the ileal bowel continuity was done in an end to end fashion in two layers using an absorbable suture. The isolated ileal segment was thoroughly washed with saline and it was folded in the form of an ā€˜Sā€™ configuration (Figure 1B, 1C). Proximal end of the S loop was closed with absorbable 3-0 suture. On the antimesenteric border of the S loop three longitudinal incisions were performed of around 7 cm in length (Figure 2A, 2B). Posterior aspects of the three limbs of the S loop were sutured to one another to create the posterior wall of the pouch using a 2-0 vicryl suture (Figure 3A, 3B). The terminal 8 cm portion of the distal part of the S loop was used for creating the nipple valve. This nipple valve was constructed by intussuscepting the distal most ileal segment into the pouch (Figure 4). The nipple valve along with the adjoining pouch wall was demucosalized and both the apposed demucosalized walls were fixed with 2-0 vicryl interrupted sutures (Figure 5A, 5B). Again the constructed nipple valve was fixed outside the pouch to the surrounding ileal serosa using an interrupted 3-0 silk suture (Figure 6). The caliber of the catheterizable channel was reduced by plicating it with vicryl sutures (Figure 7A, 7B). For creating better continence the catheterizable channel was also wrapped by the pouch wall through a mesenteric window and fixed with a silk suture (Figure 8A, 8B). The uretero-pouch anastomosis was done using the serosal lined tunnel technique (Figure 9A, 9B). Two 8 Fr ureteric splints, a 16 Fr perstomal catheter and an 18 Fr transmural pouchostomy catheter were placed. The pouch was closed by approximating the proximal and distal limbs of the S loop anteriorly by using a 2-0 vicryl continuous suture. We named this pouch as the Santosh's PGI pouch (Figure 10A, 10B, 11). The catheterizable channel was brought out through the right rectus muscle via an oblique subfascial tunnel and was fixed to the rectus sheath. After pouch reconstruction, we confirmed the catheterization of the pouch on Table. The pouch integrity and continence was checked on Table with saline. The pouch was also fixed to the parietal wall inside the abdomen. The abdomen was closed in layers after placing a 24 Fr abdominal drain (Figure 12). A follow-up pouchogram was done after 3 weeks (Figure 13). Follow-up was done by performing a VBG (venous blood gas analysis), serum creatinine and ultrasound of the kidneys, if clinically indicated.


Santosh PGI pouch: A new innovation in urinary diversion.

Kumar S, Devana SK, Sharma AP, Singh SK - Cent European J Urol (2015)

The completed Santosh PGI pouch with catheters and splints insitu and its pictoral depiction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526618&req=5

Figure 0011: The completed Santosh PGI pouch with catheters and splints insitu and its pictoral depiction.
Mentions: Midline infraumbilical incision was performed. Initially, radical cystoprostatectomy was done. After removal of the specimen, bilateral standard pelvic lymph node dissection was completed. The patient with exstrophy of the bladder underwent cystectomy only. A piece of 50-cm segment of the terminal ileum was isolated 15-20 cm proximal to the ileocecal junction (Figure 1A). Restoration of the ileal bowel continuity was done in an end to end fashion in two layers using an absorbable suture. The isolated ileal segment was thoroughly washed with saline and it was folded in the form of an ā€˜Sā€™ configuration (Figure 1B, 1C). Proximal end of the S loop was closed with absorbable 3-0 suture. On the antimesenteric border of the S loop three longitudinal incisions were performed of around 7 cm in length (Figure 2A, 2B). Posterior aspects of the three limbs of the S loop were sutured to one another to create the posterior wall of the pouch using a 2-0 vicryl suture (Figure 3A, 3B). The terminal 8 cm portion of the distal part of the S loop was used for creating the nipple valve. This nipple valve was constructed by intussuscepting the distal most ileal segment into the pouch (Figure 4). The nipple valve along with the adjoining pouch wall was demucosalized and both the apposed demucosalized walls were fixed with 2-0 vicryl interrupted sutures (Figure 5A, 5B). Again the constructed nipple valve was fixed outside the pouch to the surrounding ileal serosa using an interrupted 3-0 silk suture (Figure 6). The caliber of the catheterizable channel was reduced by plicating it with vicryl sutures (Figure 7A, 7B). For creating better continence the catheterizable channel was also wrapped by the pouch wall through a mesenteric window and fixed with a silk suture (Figure 8A, 8B). The uretero-pouch anastomosis was done using the serosal lined tunnel technique (Figure 9A, 9B). Two 8 Fr ureteric splints, a 16 Fr perstomal catheter and an 18 Fr transmural pouchostomy catheter were placed. The pouch was closed by approximating the proximal and distal limbs of the S loop anteriorly by using a 2-0 vicryl continuous suture. We named this pouch as the Santosh's PGI pouch (Figure 10A, 10B, 11). The catheterizable channel was brought out through the right rectus muscle via an oblique subfascial tunnel and was fixed to the rectus sheath. After pouch reconstruction, we confirmed the catheterization of the pouch on Table. The pouch integrity and continence was checked on Table with saline. The pouch was also fixed to the parietal wall inside the abdomen. The abdomen was closed in layers after placing a 24 Fr abdominal drain (Figure 12). A follow-up pouchogram was done after 3 weeks (Figure 13). Follow-up was done by performing a VBG (venous blood gas analysis), serum creatinine and ultrasound of the kidneys, if clinically indicated.

Bottom Line: No significant complications were noted in the pouch reconstruction.No ureteroileal anastomotic stricture or difficulty in catheterizing the pouch was seen.The Santosh PGI pouch, which is a type of CCD, is technically feasible, easy to reconstruct with acceptable continence and offers minimal morbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

ABSTRACT

Introduction: To know the feasibility and outcome of the Santosh PGI pouch as a new innovative technique of continent cutaneous diversion (CCD) following cystectomy.

Material and methods: Twelve patients (eleven with carcinoma of the bladder and one with an exstrophy of the bladder) underwent CCD using the Santosh PGI pouch after cystectomy. A 50-cm segment of terminal ileum was isolated 15-20 cm proximal to the ileocecal junction. The ileal segment was folded into the form of an 'S' configuration. On the antimesenteric border three longitudinal incisions were performed of about 7 cm in length. The terminal 8 cm portion of the distal part of the pouch was used for creating the intussuscepted nipple valve. Demucosalization of the interior of the nipple, fixing the nipple valve with the serosa of the pouch wall and wrapping of the catheterizable channel with a pouch wall for providing continence was done. The uretero-pouch anastomosis was done using the serosal lined tunnel technique. The catheterizable channel was brought out through the right rectus muscle.

Results: Median follow-up of the patients was 13.5 months. No significant complications were noted in the pouch reconstruction. Duration of the pouch reconstruction was around 75-110 min. Postoperatively, one patient had a UTI and another had paralytic ileus on the follow-up. All patients were doing regular CIC with acceptable continence of up to 400 ml. No ureteroileal anastomotic stricture or difficulty in catheterizing the pouch was seen.

Conclusions: The Santosh PGI pouch, which is a type of CCD, is technically feasible, easy to reconstruct with acceptable continence and offers minimal morbidity.

No MeSH data available.


Related in: MedlinePlus