Long-term follow up of the serosa-lined and tapered Ileum as an efferent segment of various urinary diversion reservoirs ('Fulda-nipple")

Background In 2008, Kable et al. presented the "serosalined 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. Patients and methods 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". Conclusion 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.