Stein Johannes, Müller Stefan C, Hauser Stefan, Fechner Guido
Universitätsklinikum Bonn, Urologie, Bonn.
Aktuelle Urol. 2019 Jul;50(3):268-273. doi: 10.1055/a-0667-8429. Epub 2018 Oct 24.
In 2008, Kälble et al. presented the "serosa-lined and tapered ileum" ("Fulda nipple") as a new continence mechanism of the modified MAINZ-Pouch-I. In accordance with the principle of Abol-Enein, a tapered ileum segment is embedded into a serosa-lined tunnel consisting of a second "U"-shaped ileum segment. Thus a combination of continence mechanism and pouch augmentation - which can be applied to all forms of pouches - was established.
We report on 21 patients who received a serosa-lined and tapered ileum at the Department of Urology of the University Hospital of Bonn for different indications. The aim of this study was to evaluate this technique, especially with regard to stenosis and incontinence rates in the long-term follow up. RESULTS: At a mean follow-up period of 37 months, stoma stenosis occurred in 33 % of the cases. Incontinence was observed in 21 % (n = 4) of the cases. Remarkably, two of these patients suffered from incontinence due to the phenomenon of "nipple gliding".
The long-term analysis shows similar stenosis and incontinence rates compared to the two best-established techniques - submucosally embedded appendix and intussuscepted ileum. Despite limitations due to the small number of cases, the Fulda nipple is at least a safe alternative as a "second-line technique" in cases where the initial method has failed.
2008年，卡尔布尔等人提出“浆膜内衬且呈锥形的回肠”（“富尔达乳头”）作为改良 Mainz-I 型贮袋的一种新的控尿机制。根据阿博尔-埃奈因原理，将一段锥形回肠段嵌入由另一段“U”形回肠段构成的浆膜内衬隧道中。由此建立了一种控尿机制与贮袋扩大相结合的方法——该方法可应用于所有类型的贮袋。
我们报告了21例因不同适应证在波恩大学医院泌尿外科接受浆膜内衬且呈锥形回肠手术的患者。本研究的目的是评估该技术，尤其是长期随访中的狭窄和尿失禁发生率。
平均随访期为37个月时，33%的病例出现造口狭窄。21%（n = 4）的病例出现尿失禁。值得注意的是，其中两名患者因“乳头滑动”现象而出现尿失禁。
长期分析显示，与两种最成熟的技术——黏膜下层包埋阑尾和套叠回肠相比，狭窄和尿失禁发生率相似。尽管由于病例数量少存在局限性，但在初始方法失败的情况下，富尔达乳头至少是一种安全的“二线技术”替代方案。
