Riedmiller technology

Controllable ileal bladder surgery (Kock bladder) has been improved by skinner and other techniques, but there are still some shortcomings, including the presence of abdominal ileal stoma, inadequate control of urinary spillover, difficulty in intubation caused by intussusception of nipple flap, etc. . The principle of Mitrofanoff is to control the application of the thin tubular output channel to the patient's storage wall to achieve controllable urine leakage. The output can be selected from the appendix, ureter and fallopian tube. Choosing the appendix as the output channel of the controlled urinary diversion is because it has good blood supply, good wall compliance, and can be inserted into the 12~14F catheter. It has the advantages of smooth intubation and easy necrosis, avoiding the complicated establishment. Controllable measures to achieve the effect of controlling urinary spillovers. Inverting the vascular pedicle with a free appendix and anastomosis can also make the fistula more concealed. Treatment of diseases: urinary tract obstruction interstitial cystitis Indication Riedmiller technology is suitable for: 1. Patients with bladder, urethra or female genital malignant tumor have undergone total cystectomy or pelvic organ resection, or those with unremovable lesions but urinary tract obstruction. 2. Great vaginal fistula and bladder valgus, failed after multiple operations or can not be repaired. 3. Bladder ureteral reflux caused by neurogenic bladder, repeated urinary tract infections and severely impaired renal function. 4. Tuberculous bladder spasm condensation and tuberculous urethral stricture or tuberculous vaginal fistula. 5. Interstitial cystitis, necrotizing cystitis, etc. caused by severe contracture of the bladder, showing urinary incontinence. 6. Congenital malformations or severe trauma to the lower urinary tract that cannot be repaired. 7. The following conditions are not suitable for patients with bladder surgery, this surgery can be selected: 1 bladder neck, multiple urethral tumors, postoperative urethral tumor recurrence is very likely; 2 extra-bladder tumor infiltration and metastasis, short-term postoperative Patients with pelvic tumors may relapse with radiotherapy; 3 female patients undergo radical cystectomy; 4 mesenteric membrane is short, and the formed intestinal urinary tract is difficult to be consistent with the posterior urethra. Contraindications 1. Patients with urinary tract infection fail to control; those with upper urinary tract tumors, stones or other serious diseases of the kidney. 2. Intestinal adhesions caused by abdominal trauma, surgery or inflammation, abdominal tuberculosis, tumor, inflammation or ileum have been extensively removed. 3. Serious illnesses in other systems may cause surgery. 4. There are skin diseases or infections in the surgical site, and women should suspend surgery during menstruation. 5. Weak body can not tolerate major surgery. 6. Those who have undergone pelvic radiotherapy to affect the healing of the intestine and appendix wounds should be carefully selected. 7. Appendectomy or intraoperative occlusion of the appendix cavity was found. 8. Kidney, ureter, severe water accumulation, kidney damage. Preoperative preparation Basically the same as ileal bladder surgery. Special attention should be paid to correcting anemia, controlling urinary tract infections, improving systemic conditions and renal function, and making adequate bowel preparations. Surgical procedure Incision The inferior midline incision was extended from the umbilicus 1 cm across the umbilicus. 2. Establishment of ileocecal sac The colon segment was retrieved, including the end of the ileum 10 cm, the ascending colon 18 to 22 cm, the ends were closed, and the ascending colon went to the colonic band to form a storage sac. 3. Ureter and urinary sac anti-reflux The ileum is longitudinally folded, and the ureter is anastomosed to the ileum. The method is the same as controlled ileal bladder surgery. 4. The establishment of the output track Basically the same controllable ileal bladder surgery, with a vascular pedicle free appendix through the ascending mesenteric and anastomosis. complication 1. Intestinal obstruction, intestinal fistula should pay attention to close the intestinal gap after cutting the intestine to prevent the occurrence of intestinal obstruction. Intestinal anastomosis to restore intestinal continuity should pay attention to whether the local blood supply is good, whether the anastomosis is reliable, postoperative anti-infection and supportive therapy to prevent intestinal fistula. 2. Suture of the urine-filled urinary sac, the suture of the ureter-intestinal anastomosis should be firm, and the catheter should be kept open after the operation. In the early stage, leakage of urine is required to keep the urinary catheter and abdominal drainage tube unobstructed. Antibiotics and supportive therapy are applied. Generally, leakage of urine can be stopped in about 1 week. If the urine leaks continuously and is aggravated, it needs surgical exploration. 3. Storage of urinary sac stones and other types of controllable urinary diversion, due to more intestinal mucus in the urinary sac, if the drainage or removal is not timely, the incidence of stones is higher, so the storage urinary sac should be 1~ per week. 2 times with isotonic saline or 1:5000 furancillin solution, change the body position, the residual mucus is washed out; once the stone occurs, the extracorporeal shock wave crushed stone and the gravel is washed out. 4. The ureter-intestinal anastomotic stenosis and hydronephrosis are mild, and can continue to be observed without further aggravation. If the progressive increase, or even abnormal renal function, should be surgically explored.