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At least 19 recordsLinked to original sources
PubMed1978

[Technique and results of the colon conduit, continent by means of a new magnetic stoma seal. An animal experiment study. Enterocystoplasty as model of continent urinary diversion. Review and comparison of the results of colocystoplasty, coloprostatoplasty and colourethroplasty (authors transl)].

On the basis of satisfactory results with a new magnetic stoma seal in colostomy patients, this seal, consisting of a magnetic ring and cap, was used in an experimental study to convert the colonic conduit into a continent reservoir. The aim of the study, involving 16 dogs, was to find a method of ring implantation that would avoid infection of the ring and yield complete continence in a higher percentage than had been achieved so far in patients. Complete continence was obtained in all animals but there was a 75% incidence of immediate and delayed infection of the magnetic ring when the ring was inserted transcutaneously. In contrast, all rings were well accepted by the tissue when the procedure was staged with the ring being implanted transperitoneally several weeks prior to fashioning of the conduit. The general problems arising from the colonic conduit when used as continent reservoir are known from the results of colocystoplasty, coloprostatoplasty and colourethroplasty, which are reviewed and compared with our observations. Residual urine was low due to an ideal energy-balance pattern. Coloureteric reflux was successfully prevented in all cases operated on by a long-tunnel modification of the Leadbetter-Clarke technique. Hyperchloremic acidosis and renal function deterioration were not observed. All conduits were infected.

Animals↗
PubMed1978

Continence in cases of bladder exstrophy.

The relationship of the onset of continence, staged surgical procedures and continence length was investigated in 21 patients with closed continent exstrophy. Continence occurred within a year of operation in 13 patients and 10 of these 13 patients had a Young-Dees urethroplasty and Marshall-Marchetti-Krantz suspension. In 11 of these 13 patients the continence length was greater than 1 cm. In the remaining 8 patients continence was delayed beyong a year. Only 1 of these 8 patients had undergone both bladder neck procedures and in 5 patients the continence length was greater than 1 cm.

Adolescent↗
PubMed1977

Stagnant loop syndrome in patients with continent ileostomy (intra-abdominal ileal reservoir).

Intestinal absorption and bacteriology of the ileal contents were compared in seven patients with continent ileostomy and seven patients with conventional ileostomy. The absorption of vitamin B12 was reduced in five patients with continent ileostomy and subnormal in two patients with conventional ileostomy. Steatorrhoea was present in four patients with continent and one patient with conventional ileostomy. Increased concentrations of total anaerobic bacteria and Bacteroides were found in the ileum of the patients with continent ileostomy. After an oral dose of (1-14C) glycocholic acid there was no difference in the faecal excretion of radioactivity, whereas the 14CO2-expiration was increased in two patients with continent ileostomy. In four patients with continent ileostomy and malabsorption of B12, there was evidence of a stagnant loopsyndrome as oral lincomycin treatment resulted in increased absorption of B12 decreased excretion of faecal fat, and decreased concentrations of Bacteroides in the ileum.

Adult↗
PubMed1978

Radiologic evaluation of the continent (Kock) ileostomy.

The continent ileostomy is a solution to the persistent difficulties of leakage, odor, and skin irritation produced by the conventional permanent ileostomy in patients who have had proctocolectomy. Patients with continent ileostomy do not use ileostomy appliances, have complete fecal continence, and need empty the ileal reservoir only 2 to 4 times a day. Radiographic examination is often of great value in assessing patients with continent ileostomy. Radiographic features of the normal continent ileostomy and complications of continent ileostomy are discussed with regard to plain film and contrast examinations.

Humans↗
PubMed1976

[Urinary continence after radical prostatectomy: the urodynamic proof of an anatomical hypothesis (author's transl)].

Prostatic carcinoma can be cured by a radical operation. In radical prostatectomy the whole so-called internal sphincter is removed. It is generally accepted and often proved that the external sphincter which is mostly somatically innervated cannot resume the funciton of continence. The postoperative urinary incontinence after radical prostatectomy is frequent and therefore the radical prostatectomy is not performed in many places. The problem of postoperative continence as well as incontinence after enucleation of the adenoma will be briefly discussed. In 1966, HUTCH described the so-called 'baseplate'. It is a bundle of smooth muscle fibers, circulary arranged around the bladder neck, which are also responsible for passive continence. He proposed that a certain sphincter function can be achieved by a tubular anastomosis of this anatomical substratum with the distal urethral stump. We were able to prove this anatomical hypothesis urodynamically. A specially constructed double-lumen perfusion catheter enabled us to register the so-called functional urethra profile and simultaneously register a new sphincter pressure wave in the transformed 'baseplate' which was responsible for the continence. We could observe this new sphincter region in all continent patients after radical prostatectomy whereas in the incontinent patients it was absent. Since 1972 we have employed the procedure proposed by HUTCH and have performed 20 radical prostatectomies. All these patients have been postoperatively completely continent. We are of the opinion that undue restraint concerning radical prostatectomy is no more justified.

Humans↗
PubMed1977

A continent colostomy: The magnetic stoma cap.

An apparatus to create continence in an end left-sided colostomy in dogs is assessed. The device consists of a samarium-cobalt magnetic ring encased in methyl methacrylate and a magnetic cap. The ring is implanted in the abdominal wall and the colon delivered through it and matured to the skin. The stoma is later obturated by the magnetic cap to provide continence. Ten dogs exposed to "uncoated" samarium-cobalt magnets for periods of up to eight months showed no elevation of cobalt levels in the serum or tissues and no histopathologic changes on postmortem examination. In twelve dogs, magnetic rings were used to create continent colostomies. Eleven of twelve dogs followed for periods up to eight months were continent and tolerated the appliance well. One ring was extruded after a peristomal skin dehiscence occurred. Two skin strictures appeared and were readily controlled by digital dilatation. Sinus, fistula, or infection were not seen. Clinical application of this device is discussed.

Abdominal Muscles↗
PubMed1979

A clinical and manometric correlation for assessment of postoperative continence in imperforate anus.

Functional results after surgical correction of anorectal malformations were assessed on a clinical basis following Kelly score and by manometric study. Forty-six patients, aged 2--17, were personally interviewed and 25 of these 46 had manometric studies to evaluate postoperative continence. The manometric study was also performed on 35 normal children as a control group. Continent patients characteristically had marked high pressure zones as did the normal subjects. On the other hand, in the patients with fair or poor results, the anorectal pressure profile had no marked high pressure zone in the anal canal. The presence of normal anal pressure at rest as well as adequate ano-rectal pressure difference was found to correlate well with continence. In patients with perineoplasty, the ano-rectal reflex correlated well with continence but not in patients treated by abdominoperineal rectoplasty.

Adolescent↗
PubMed1979

The urethral pressure profiles in continent and stress-incontinent women.

Simultaneous urethrocystometry, including recording of the urethral pressure profile, was performed in 127 women aged 30 to 69 years; 42 of the women were free from urologic disorders and 85 had stress incontinence of urine. Both groups were subgrouped according to age. The results in the continent and the incontinent women were analyzed separately, in order to disclose any age-related changes. The data within each decade of age were also comparatively analyzed. In the bladder pressure at rest no age-related changes were found, and the readings were similar in the continent and the incontinent women. The maximum urethral pressure fell significantly with rising age in both groups and was significantly reduced in stress incontinence. The urethral closure pressure showed variations similar to those in the maximum urethral pressure. No lower limit of urethral closure pressure that definitely predisposed to stress incontinence could be established. The functional length of the urethra diminished significantly with rising age in the continent, but not in the incontinent women. The absolute length of the urethra did not show such diminution. Both the functional and the absolute urethral length were significantly less in the incontinent than in the continent women in the age groups between 30 and 49 years.

Adult↗
PubMed1977

The gastric bladder: a continent reservoir for urinary diversion.

A continent reservoir ("gastric bladder") has been developed as an alternative to ileal conduits after urinary diversion procedures. The reservoir is fashioned from vagally denervated gastric fundus and has antireflux ureterogastric anastomoses and a continent "neourethra," the latter which is easily catheterized to empty the contents; the main stomach retains vagal innervation. Continent reservoirs were prepared in six dogs, and Heidenhain pouches (without urinary diversion) were prepared in six control dogs. Effects of short-term and long-term exposure of gastric mucosa to urine and 1M, 2M and 4M urea solutions were studied. Basal and food-stimulated acid outputs were unaffected by prolonged exposure. Mucosal permeability to H+, Na+, K+ and Cl- after exposure to urine remained unaltered, but 4M urea solutions produced a temporary increase in permeability. Mucosal blood flow was unchanged. Reservoir capacity rapidly increased up to 2,000 ml without any change in serum electrolytes. No precipitation of uric acid occurred. No histologic differences were noted between the main stomach and the reservoir. Because gastric mucosa (especially when acidified) is relatively impermeable to ions, secretes rather than absorbs Cl-, and is unaffected by prolonged exposure to urine, a gastric pouch may be useful as a continent urinary reservoir while allowing the maintenance of normal serum electrolytes.

Animals↗
PubMed1978

Urethral closure pressure with stress--a comparison between stress-incontinent and continent women.

Stress incontinence has been said to occur as a consequence of a low urethral pressure and defective pressure transmission from the abdomen to the urethra due to descent of the bladder neck area. Equipment suitable for dynamic pressure measurements has been used to analyse the losses of urethral pressure that lead to incontinence. The pressure transmission from abdomen to urethra was found to be incomplete in both continent and stress-incontinent women. There was also significant loss of smooth muscle tone in the urethral wall after repeated straining, leading to a still narrower margin between the urethral pressure and the leakage treshold in both continent and stress-incontinent women. The main factor determining the degree of continence or incontinence seemed to be the urethral closure pressure at rest . As long as this pressure is sufficiently high, leakage during sudden stress will not occur.

Adult↗
PubMed1979

Complications of continent ileostomy.

Immediate postoperative complications occurred in 15 per cent of 39 patients undergoing continent ileostomy, and late complications developed in 46 per cent of these patients. Age over 40 years, obesity, and Crohn's disease were related to the morbidity rate, but corticosteroid therapy was not a factor. Results of primary operations were superior to those of secondary continent ileostomies. With careful selection of patients and attention to technical detail, success in 90 per cent of initial continent ileostomy operations is a realistic goal.

Adolescent↗
PubMed1977

Continent cecoileal conduit: preliminary report.

A continent cecoileal conduit to improve rehabilitation after external urinary diversion is described. The isolated cecum functions as a reservoir. The continence mechanism is constructed by intussuscepting the terminal ileum into the isolated cecum to form a nipple, preventing leakage of urine. The kidneys are protected from cecoureterorenal reflux by ureterocecostomies with submucous tunnels. We have used this technique on 4 patients, 2 of whom need no external urinary pouch since the urostoma is absolutely continent. One patient became incontinent 3 months postoperatively and is wearing a conventional bag and 1 patient died. There is no refluex into the kidneys. The upper urinary tract, which is dilated slightly 4 weeks postoperatively, tends to become normal after a few months.

Cecum↗
PubMed1978

A continent ileostomy and reservoir using the canine ileocolonic segment.

The present study was an attempt to create a simple reservoir with a reliable continent ileostomy, so as to overcome the many drawbacks of the regular ileostomy. The ileocolonic segment was isolated and the ileum was intussuscepted into the colon to augment the ileocolonic sphincter. Pressure recordings disclosed a high pressure zone in the ileocolonic sphincter area reacting with a significant pressure increase to colonic distention. The proximal ileal end was anastomosed to the colonic part of the ileocolonic segment, and the ileal part of the ileocolonic segment was maturated as an ileostomy. The colonic reservoir was emptied by catheterization. Between catherizations, the ileostomies remained completely continent to small intestinal contents and gas. The reservoir and continent ileostomy are easily constructed, offer convenience and safety, voluntary and controlled emptying and conservation of part of the water and sodium excessively lost with conventional ileostomies. The procedure should be applied only to those patients in whom the right colon is unaffected or only slightly affected by the inflammatory process.

Animals↗
PubMed1977

Dynamics of the continent ileal bladder. An experimental study in dogs.

A continent ileal bladder was constructed in six dogs. The most important requirements for a continent ileal bladder as a reliable mechanism of continency and for prevention of back flow in the ureters could be achieved by two intussusception valves (nipples) of small bowel in opposite directions. The dynamics of these "nipple valves" were studied electromanometrically and radiologically. These experiments showed that these intussusception valves did not binder a free flow in the isoperistaltic direction and did prevent reflux in the antiperistaltic direction.

Animals↗
PubMed1979

Radiological assessment of nipple-valve insufficienty in Kock's continent reservoir ileostomy.

In a series of 51 continent reservoir ileostomies nipple-valve insufficiency developed in 15 patients who were examined radiographically to find the cause for the loss of continency. The radiological diagnosis was confirmed at reoperation. The causes for nipple-valve insufficiency were a total or partial disappearance of the nipple-valve by sliding of the invaginate (7 cases) and dislocation of an undamaged nipple out of the reservoir (8 cases). In these groups the radiological diagnosis was compatible with the operative findings in all but one case. At reoperation a fistula in the nipple-valve was found in 3 cases, but in no instance had this been diagnosed radiologically. A correct preoperative diagnosis is valuable, especially in cases of dislocation, where a danger exists that the real mechanism of valve insufficiency may remain obscure at operation.

Humans↗
PubMed1977

[Continence after low anterior resection (author's transl)].

In 28 patients we studied the fecal continence after low anterior resection of the rectum. After an usual proctological investigation we did in all patients measurements of the anorectal function, such as pressure measurement, electromyography and determination of the anal-rectal angle. In 12 patients a defecatogram was performed. Of the 28 patients with anastomoses lower than 8 cm only one was after 2 years still incontinent. All the other patients were completely continent. This fact could be proven objectively.

Adult↗
PubMed1978

Closure of the bladder neck in patients undergoing continent vesicostomy for urinary incontinence.

The continent vesicostomy has been done on 24 patients, 10 of whom had severe urinary incontinence requiring closure of the bladder neck or urethra as well. Therefore, the bladder was converted to a closed cavity and intermittent catheterization is done through an abdominal stoma. No dressings or appliances are necessary. Bladder neck (or urethral) closure was successful in 8 of the 10 patients. One of the failures had been incontinent and was rendered continent on attempted bladder neck closure and there is urethral leakage at night in the other patient. Intermittent catheterization through a vesicostomy stoma has been cleaner and more aesthetically pleasing to the patients. The bladder neck closure has resulted in a dry perineum with fewer skin problems.

Adolescent↗