[Reifensteiner pouch: A simplified ileum-colon pouch with umbilical-stoma based on the Mainz pouch I]

Continent urinary diversion after radical cystectomy is the method of choice for suitable patients. For patients, in whom orthotopic bladder replacement with connection to the urethra stump is not possible, different pouches have been developed mostly with anastomosis to the umbilicus. These pouches have to be constructed with regard to three major principles: First, it has to be built as a low-pressure reservoir which does not interfere with high-pressure peaks during filling. Second, a direct transmission of the pressure by reflux from the pouch to the urinary system of the kidney has to be avoided. Finally, a sufficient continence mechanism has to be built to avoid urinary leakage. The standard procedure is the Mainz I pouch. This method is technically challenging and burdened with multiple complications regarding the continence mechanism, which is made by submucous placement of the appendix. Therefore, this operation is mostly performed in specialised centres. In this paper a simplified version of the continent umbilical pouch is, which has been applied in 11 patients. Instead of building the continence mechanism by using the appendix, the continent umbilical pouch acts as a natural valve. To prevent pressure transmission to the upper urinary tract, a part of the terminal ileum is connected proximally, which is built like an ileum conduit. Thereby it is possible to protect the upper urinary tract, as the pressure transmission from the pouch is not reduced by a static antireflux mechanism but by an air-chamber-like-mechanism. By means of the combination of urological standard procedures (like the ileum conduit) and a pouch, which is less challenging to construct, this method is technically simplified and therefore reduces operating time. Stoma stenosis, which had occurred in the first operated patients, was avoidable by a minimal change in technique in the following patients. Other complications that we saw (hernia, mucous tamponades), were not related to the used urinary diversion method. Therefore, this procedure is practical, technically simple and the results for patients are satisfying. This kind of continent pouch with umbilical stoma offers the opportunity for more patients to be operated on with this method. Further observation of the operated patients, possibly with with urodynamic examination, is necessary.