A right colon pouch with a novel efferent channel concept: long-term results of the Turin pouch
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ORIGINAL ARTICLE
A right colon pouch with a novel efferent channel concept: long‑term results of the Turin pouch G. Muto1,2 · A. Giacobbe1 · D. Collura1 · F. Germinale1,2 · M. Kurti1 · R. Papalia3 · G. L. Muto4 · E. Berdondini1 · P. Caccia1 · N. Faraone1 · E. Giargia1 · G. Leucci1 · L. Tosco1,2 Received: 21 April 2020 / Accepted: 12 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To report stoma stenosis rates and efferent channel (EC) complications at long term follow-up for Turin pouch (TP). Methods This is a retrospective analysis of the prospectively maintained database of patients who underwent TP between March 2006 and May 2018. The TP is a U-shaped right colon pouch. The EC was conceived by the tubularization of 5 cm of the colon wall with the use of a stapler and sutured to the skin (EC-cutaneostomy). The ureters are sutured separately to the last 10 cm of ileum before the ileocecal valve. In literature, catheterization problems have been described on average in 20.3% of patients and stoma stenosis in 19.5% of the patients with flap valve systems. Results Thirty-eight consecutive patients underwent a TP procedure. The median age was 55 years (IQR: 52–60). Median operative time was 201 min (IQR: 170–210), median reconstructive time was 61 min (IQR: 55–65) and the blood loss was 244 ml (IQR: 150–300) and 4 patients (10.5%) needed blood transfusions. The median follow-up was 52 months (IQR: 37–92). Complete 24h continence was achieved in 34 (89%) patients. Seven (18.4%) patients reported difficulties in EC catheterization and 4 (10.5%) patients had stoma stenosis. This study is limited by the relatively small number of patients. Conclusion In relation to similar systems, the TP seems to offer comparatively good functional results but EC and stoma complications were lower than other pouch variants in literature. Keywords Bladder · Continent · Cutaneous · Urinary diversion · Efferent channel · Stoma stenosis
Introduction The application of external urinary diversions is needed in many clinical scenarios, ranging from oncologic diseases (urological, gynecological) to functional urological Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03412-8) contains supplementary material, which is available to authorized users. * F. Germinale [email protected] 1
Department of Urology, Humanitas Gradenigo Hospital, Turin, Italy
2
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
3
Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
4
Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
problems. In these clinical situations, patients ask for a heterotopic urinary diversion that could improve or minimally change their quality of life, and their body image and that could decrease the rate of possible complications. In recent years, many different surgical techniques have b
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