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Die Konstruktion eines Harnreservoirs aus Darmanteilen hat drei funktionelle Ziele: 1. Niederdruckreservoir, 2. Antirefluxschutz, 3. zuverlassige Kontinenzkontrolle. Die dargestellte neue Technik eines Ileozokalpouches (Mainz-Pouch) ist in ahnlicher Form sowohl fur die Blasenaugmentation als auch fur die kontinente supravesikale Harnableitung anwendbar. Ein Niederdruckreservoir wird durch die longitudinale antimesenterielle Darmeroffnung mit Durchtrennung der zirkularen Muskelkontinuitat von Ileum und Zokum und Pouchbildung aus Zokum und zwei terminalen Ileumschlingen erzielt. Zum Antirefluxschutz dient eine Standardtechnik mit submukoser Tunnelbildung bei Ureterimplantation in das Zokum bzw. Colon asdendens. Die klinische Anwendung dieser Technik in 4 Fallen zur Blasenaugmentation und weiteren 6 Fallen zur supravesikalen Harnableitung bestatigt das funktionelle Konzept des Mainz-Pouches: Die Kapazitat der Reservoirs betragt 350-600 ml mit intraluminalen Drucken von 20-40 cm H2O bei 50% Fullung und 30-45 cm H2O bei Maximalfullung. Bei provokativer Fullung mit einer Fullungsgeschwindigkeit von 60 ml/min startet die kontraktile peristaltische Aktivitat bei einem Fullungsvolumen von 250 ml, die maximalen intraluminalen Drucke betragen 55 cm H2O (45-70 cm H2O). Ein ureteraler Reflux trat in keinem Fall auf. Im Urogramm sind die oberen Harnwege nicht dilatiert oder im Vergleich zur praoperativen Stauung gebessert mit Ausnahme einer beidseitigen Grad I-Dilatation. Alle Patienten mit Mainz-Pouch-Blasenaugmentation sind tags und nachts vollstandig trocken bei normalen Miktionsintervallen. Zwei Patienten mit Mainz-Pouchsupravesikaler Harnableitung haben eine alloplastische Sphinkterprothese zum Verschlus des Pouches, zwei andere sind aufgrund einer antiperistaltischen peripheren Ileuminvagination kontinent, bei zwei weiteren steht die Implantation eines Sphinktermechanismus noch aus. Reconstruction of urinary reservoir from bowel basically aims at three functional features: 1. low pressure reservoir, 2. antirefluxive ureteral implantation and 3. reliable sphincteric control of continence. A new technique for fashioning an ileocoecal pouch is described, which is applicable for bladder augmentation as well as continent urinary diversion. A low pressure reservoir is achieved by antimesenteric longitudinal transsection of circumferential muscular continuity of ileum and coecum and formation of a pouch from coecum and two ileal loops. The antirefluxive procedure is a submucous tunnel implantation of ureters into coecum. Clinical application of the operative technique in 4 cases for bladder augmentation and another 6 cases for urinary diversion has proved the validity of our functional concept: Capacity of the reservoirs ranges from 350-600 ml. Intraluminal pressures are 20-40 cm H2O having the reservoir filled at 50% of and 30-45 cm H2O at maximum capacity. During provocative urodynamic investigation with a filling rate of 60 ml/ min, contractile reservoir activity Startes at 250 ml filling volume creating maximum intraluminal pressures of 55 cm H2O (45-70 cm H2O). Ureteral reflux was not observed. IVP reveald no or reduced dilatation of upper tracts compared to preoperatively in all patients with exception of one bilateral grade 1 dilatation. All of the patients with MAINZ-Pouch bladder augmentation are completely dry day and night with normal intervals of bladder evacuation. Two patients with MAINZ-Pouch urinary diversion rely on an alloplastic stomal prothesis for continence, another two are continent due to an antiperistaltic peripheral ileum invagination, the remainder are awaiting implantation of a sphincteric device.

In stone surgery the operative approach aims not only at complete removal of stones, but also at minimizing damage to the intrarenal arteries and parenchyma. In complicated staghorn or calyceal stones, our concept is to remove as many stones as possible through an extended pyelocalicotomy and the residual calyceal stones via minimal radial nephrotomies. To accomplish an atraumatic nephrotomy, the shortest transparenchymal route should be chosen, and damage to the intrarenal arteries must be avoided. Doppler sonography for intraoperative localization of the intrarenal arteries and combined B-scan sonography for intraoperative localization of stones allow an avascular, atraumatic nephrotomy, in which clamping of the renal artery and cooling are no longer necessary. In 35 operations with a total of 109 radial nephrotomies, clamping of the renal artery was required in only 2 cases. By comparing the preoperative and 6-week postoperative functional results, split 131I-hippuran clearance demonstrated only 7% loss of function of the operated kidneys.

Digital subtraction angiography was compared to computerized tomography and histopathological findings for staging renal cell carcinoma in 24 patients. Injection of contrast material through a 16 gauge angiocatheter into the femoral vein provided digital subtraction cavography, digital subtraction arteriography and excretory urography during 1 investigation. Computerized tomography established the diagnosis in all patients, while digital subtraction angiography showed all angiographic signs of renal cell carcinoma in 14 (58 per cent). T staging was correct on computerized tomography in 18 patients and on digital subtraction angiography in 16. Absence or presence of venous involvement was indicated correctly by computerized tomography in 20 patients and by digital subtraction angiography in 21. In small tumors the combination of ultrasonography, digital subtraction angiography and excretory urography is sufficient for an operation. In all other tumors digital subtraction angiography cannot replace computerized tomography but adds useful information about arterial distribution, possible venous tumor thrombus and the anatomical relationship of vessels.

Among congenital urethral malformations, posterior urethral valves represent one of the main causes of severe infravesical obstruction in children, the etiology and embryological development of which remains unclear. Posterior urethral valves of types I and III are supposed to be related to either the persistence of connective tissue along the pathway of migration of the Wolffian duct (type I) or a residual part of the endodermal urogenital membrane (type III). A possible reason for supramontane urethral valves (type II) is seen in the persistence of crest-shaped tissue along the ureter's pathway in embryological development to its final site, although there is some doubt as to the existence of type II valves and they were not seen in the 65 cases of posterior urethral valves in our own material.

The ideal urinary reservoir constructed from bowel material should be a low-pressure system with a high capacity, capable of preventing upper tract deterioration resulting from ureteral obstruction or reflux. It should achieve reliable control of continence and assure easy emptying of the reservoir. In the Mainz-pouch, the combination of cecum and ileum, the latter of which is able to absorb pressure waves created by the cecum, produces a low-pressure system with a high capacity immediately postoperatively. By incorporating large bowel in our pouch, ureteral implantation can be done using a simple and reliable standard antireflux technique with a submucosal tunnel. The Mainz-pouch has been done since 1983 in 26 patients. Of these 11 were for bladder augmentation after subtotal cystectomy and 15 for continent urinary diversion. All of the patients with bladder augmentation are completely dry day and night; 2 patients with myelomeningocele are on intermittent catheterization for bladder evacuation. The remainder void spontaneously without significant residual urine. Of 15 patients with Mainz-pouch urinary diversion, 4 had an alloplastic stomal prosthesis implanted for control of continence and 11 have isoperistaltic ileo-ileal invagination, where by the invagination valve can easily be fixed to the intussuscepting ileum by sutures or staples. Of the 4 alloplastic stomal prostheses, 2 have been removed because of infection. In 1 of these patients, an ileo-ileal invagination was performed in the same operation to achieve continent closure. All patients with the invagination valve, as well as the 2 patients with an alloplastic stomal prosthesis, are completely continent, but in 3 cases, revision of the ileo-ileal invagination became necessary due to prolapse of the valve.

Vesical smooth muscle cells were grown in enzyme-dispersed cell culture, and contractions of single cells were induced by various exogenous neurotransmitters or analogues. This model may be suitable for studying the physiologic properties of smooth muscle cells in culture and thus cell differentiation and changes under defined conditions of culture. The effects of various drugs on single muscle cells may be compared: The pharmacologic effect on the muscle can thus be judged intrinsically without the interferences inherent in the natural milieu and from pharmacologic effects on the central or peripheral nervous system.

To study the applicability of telemetry in urodynamics, 10 healthy males were evaluated by both standard and telemetric urodynamic techniques. TV observation made correlation of the data with the actual situation possible. During bladder filling, intravesical pressure could be registrated in a lying, sitting and standing position. Stress conditions such as walking, running, climbing steps, kneebends, push-ups and even handstands were tested. Detrusor instability was detected with telemetric techniques in 6 volunteers, while regular cystometry showed evidence of instability in only 2 cases. Desire to void occurred in telemetric studies at lower bladder volume than in regular cystometry. A normal voiding phase was registered in all telemetric investigations, while 3/10 men displayed an abnormal micturition pattern in regular sitting cystometry. The advantages of telemetric urodynamic investigations are: (1) simulation of several stress conditions because of the patient's independence of stationary laboratory equipment; (2) lowered psychogenic stress as the patient is left undisturbed and can urinate in a normal position and (3) 24-hour investigations. It is indicated in (1) incontinence if no urine loss can be detected by regular cystometry; (2) micturition disorders in psychogenic inhibition of micturition is suspected, and (3) enuresis if 24-hour investigations are desired.

Urinary incontinence in 80 men was classified by combined radiological and urodynamic techniques. 28 cases of pure stress incontinence were evaluated for grading of sphincteric loss. Clinical and sphi

Under conditions of stress, the urethral sphincteric mechanism has to compensate a passive bladder pressure rise induced by increase in intraabdominal pressure. To evaluate the various closure mechanisms contributing to urethral response to stress, we subjected a female dog model to the physiologic stress condition triggered by sneezing. Vesical, rectal and 4 urethral pressures during sneezing were recorded simultaneously under various experimental situations: in the intact animal, after transection of the bladder and urethra, and with the abdomen open. The effects of the Crede maneuver and of manual squeezing of the surgically exposed bladder were also recorded. The data obtained support the existence of a 2-component urethral closure mechanism under stress: the proximal closure mechanism of the smooth muscular, intrapelvic urethra is from passive transmission of abdominal pressure. It is apt to balance a passive increase in bladder pressure and thus maintain proximal closure pressure during stress. The distal closure pressure mechanism reflects active reflex contraction of the intrinsic external sphincter and pelvic floor muscles, which is capable of exceeding passive increase in bladder pressure and thus augments closure pressure during stress.

Summary— The use of the Doppler probe to localise the intrarenal vessels was assessed in 15 dogs. This prevented the need for renal artery clamping and radial nephrotomies were placed in silent areas on the renal surface. Functional studies were performed post-operatively at 48 h and 1 month, using creatinine clearance, microfil casts and cast angiography. There was no significant loss of function when three or six radial nephrotomies were made and the Doppler accurately localised sites for nephrotomy between the intrarenal arteries and veins which were undamaged.

The ideal urinary reservoir constructed from bowel material should be a low-pressure system with a high capacity, capable of preventing upper tract deterioration resulting from ureteral obstruction or reflux. It should achieve reliable control of continence and assure easy emptying of the reservoir. In the Mainz-pouch, the combination of cecum and ileum, the latter of which is able to absorb pressure waves created by the cecum, produces a low-pressure system with a high capacity immediately postoperatively. By incorporating large bowel in our pouch, ureteral implantation can be done using a simple and reliable standard antireflux technique with a submucosal tunnel. The Mainz-pouch has been done since 1983 in 26 patients. Of these 11 were for bladder augmentation after subtotal cystectomy and 15 for continent urinary diversion. All of the patients with bladder augmentation are completely dry day and night; 2 patients with myelomeningocele are on intermittent catheterization for bladder evacuation. The remainder void spontaneously without significant residual urine. Of 15 patients with Mainz-pouch urinary diversion, 4 had an alloplastic stomal prosthesis implanted for control of continence and 11 have isoperistaltic ileo-ileal invagination, where by the invagination valve can easily be fixed to the intussuscepting ileum by sutures or staples. Of the 4 alloplastic stomal prostheses, 2 have been removed because of infection. In 1 of these patients, an ileo-ileal invagination was performed in the same operation to achieve continent closure. All patients with the invagination valve, as well as the 2 patients with an alloplastic stomal prosthesis, are completely continent, but in 3 cases, revision of the ileo-ileal invagination became necessary due to prolapse of the valve.

Twenty-two pacemaker pulse generators were exposed to shock waves of an extracorporeal shock wave lithotripter to assess the effects of the extremely high pressure transients on pacemaker function. The pulse generator and distal aspect of the lead were positioned 5 cm from the focal point of the lithotripter and 10 cm from each other. Pulse generator function was analyzed during shock wave delivery synchronized with pulse generator output, during shock waves at a rate faster than the escape rate, and after exposure to lithotripsy. During shock waves delivered synchronously with pulse generator output, only one of 22 pulse generators malfunctioned by intermittently reverting to the magnet rate. When subjected to shock waves at a rate greater than the escape rate, 50% of the pulse generators were inhibited by electromechanical interference from the lithotripter. Both bipolar and unipolar devices were affected. However, analysis after exposure to shock waves showed that none of the pacemakers was damaged or spuriously reprogrammed. In conclusion, cardiac pacemakers do not appear to be damaged or reprogrammed by exposure to extracorporeal shock wave lithotripsy. The likelihood of false inhibition appears to be very low if shock waves are delivered synchronously with the QRS.

Summary— The sapphire crystal infrared photocoagulator and polyglactin (Vicryl) mesh, two new methods for closure of radial nephrotomies, were assessed in 16 dogs. Six radial nephrotomies were carried out in each dog; in 10 the nephrotomies were sealed by the infrared photocoagulator and in six they were left open, but the kidney was covered with a polyglactin mesh. Functional and morphological studies were performed using creatinine clearance, microfil casting, corrosion cast angiography and histology. There was no significant loss of function or loss of renal tissue. Both methods were shown to be safe and effective in the closure of radial nephrotomies.

For prosthetic use in genitourinary operations we investigated the feasibility of producing grafts from cultured smooth muscle cells on absorbable synthetic biomaterial. Biopsies of bladder wall muscle without mucosa were obtained from 20 rabbits for culture of smooth muscle cells; cultured cells were examined by light and electron microscopy. Those cells were grown in subculture on a microfiber mesh carrier woven from 35-denier polyglycolic acid fibers. As shown by scanning electron microscopy (SEM), complete coverage of the synthetic fabric was achieved after ten to fourteen days of subculture.

In an attempt to solve the problem of chemosensitivity testing of renal cell carcinoma in vitro, a modified short-term culture technique was developed. The kinetic study of hypernephroma cells and normal renal cells showed that the uptake of H3-uridine and H3-thymidine is at its maximum after eighty hours. The effect of doxorubicin, cisplatinum, vinblastine, and mitomycin C in different concentrations was tested. Tumors generally showed more resistance than sensitivity. Some tumors showed sensitivity to one or more drugs, but no one drug was persistently effective in all tumors. Our short-term culture technique solved the discrepancy between cell kinetics and test duration found in the Volm test and the problem of nongrowth in the clonogenic assay.

The striated musculature of the dog urethra was studied histochemically. Two main groups of muscle fibers could be identified: 1 with slow twitch oxidative fibers, which are fatigue resistant (type 1), and 1 with fast twitch fibers (type 2). The fast twitch fibers were subdivided into glycolytic (fatiguable) and oxidative glycolytic (fatigue resistant) fibers: the latter constitute 20 per cent of all fast twitch fibers. Type 1 constitutes 35 per cent of the whole musculature and its proportion tends to decrease toward the distal end of the external urethral sphincter. From these observations we infer that type 1 fibers are likely responsible for continence at rest and that type 2 fibers are recruited in stress conditions, for example, during coughing or sneezing. Additional studies are needed to confirm this conjecture. The clinical implications of these studies for the control of incontinence, urinary retention and dyssynergic urethral sphincter are presented.

38 patients with severe urge or urge incontinence, who did not respond to conservative therapy, were treated with selective sacral nerve blockade using a local anesthetic (bupivacaine). 6 patients of this group had definite selective sacral denervation with phenol. In 31 patients a urodynamic study was done previous to the sacral nerve block as well as 10 and 90 min after the injection. Within the first 2-7 weeks the success rate was about 70% in regard to bladder capacity and mean volume at first desire to void. On long-term follow-up (greater than 7 months), the success rate decreased to about 16%. Only 1 patient of the phenol group still has complete detrusor areflexia for now more than 2 years. 4 male patients with advanced or locally recurrent bladder tumors had the sacral block because of severe perineal or suprapubic pain. Subjectively their response seemed to be better. According to our experience nonoperative central bladder denervation with selective sacral nerve blockade using local anesthetics or phenol shows no convincing results on long-term follow-up. Since it is a minimal invasive technique, which can be repeated several times, it may be helpful for some patients and offers a chance to bypass major surgical denervation procedures.

To investigate the feasibility of chronic stimulation of the sacral nerves for control of sphincter and bladder function, we implanted bipolar electrodes in 10 dogs. These electrodes, of conventional cuff (4 dogs), as well as innovative spiral designs (6 dogs) were placed around the S2 roots of the 10 dogs and in 3 of them around the S1 root additionally. The electrodes were connected to subcutaneous radiofrequency receivers for external activation. Microsurgical techniques were employed to perform dorsal rhizotomy and ganglionectomy. 5 dogs, 3 kept as long as 8 months, were chronically stimulated to a cumulated time of 100-150 h each. Functional and histological results reveal that sacral root nerves can be stimulated safely on a chronic basis for effective control of the lower urinary tract.

Chronic electrostimulation of the sacral roots induces an increase in urethral resistance due to activation of muscles of the striated urethral sphincter. Histochemical study of the urethral striated musculature (nonstimulated) revealed 3 main varieties of fibers: 1) Slow twitch fibers (35 per cent of the whole muscle); 2) Fast twitch fatiguable fibers (52 per cent); and 3) An intermediate type, fast twitch fatigue resistant (13 per cent). Ten dogs with chronically implanted electrodes at the 2nd sacral root were subjected to a program of prolonged stimulation under anesthesia. After prolonged electrostimulation, we detected hypertrophy of the striated muscle fibers of the urethra, anal sphincter and stimulated side of the tail. The stimulated muscle fibers showed a higher overall oxidative activity than the controls. This occurred both in intact and spinalized animals. We thus expect the urethral striated musculature to be more resistant to fatigue because of the increased oxidative activity. Stimulated fibers also had increased glycolytic activity as shown by the enhanced intermyofibrillar deposition, especially in the fast twitch fibers. The increased glycolytic activity may also increase fatigue resistance by producing energy during periods of low oxygen supply at the peak of muscular contraction. As a consequence of increase in oxidative and glycolytic capacities and muscular hypertrophy, we expect that the striated musculature of the urethra will be not only more resistant to fatigue but also capable of generating higher tension. Both are important in achieving continence via electrostimulation of sacral nerve roots. Approximately 3 months after conclusion of the stimulation program these changes had gradually reverted to the normal prestimulation level.

The surgical technique for creation of the Mainz pouch uses 10 to 15 cm. of cecum and ascending colon and 2 ileal loops of the same length for construction of a urinary reservoir. Initial applications of the Mainz pouch were for bladder augmentation after subtotal cystectomy and for continent urinary diversion. Current indications have been extended to complete bladder substitution after radical cystoprostatectomy with anastomosis of the pouch to the membranous urethra. For cosmetic reasons the umbilicus is used as a stomal site for continent urinary diversion, and the technique of intussuscepting the continence nipple has been modified accordingly. A total of 100 patients underwent a Mainz pouch procedure since 1983: 34 for bladder augmentation, 15 for total bladder substitution after cystoprostatectomy and 51 for continent urinary diversion. In the bladder augmentation group 1 patient underwent conversion to a continent stoma, 1 has urge and frequency, and the remaining 32 are completely dry day and night. These patients empty the bladder at normal intervals spontaneously except for 3 who rely on intermittent catheterization. In the bladder substitution group 1 patient has grade 1 stress incontinence and the remainder are completely dry during the day. However, at night 4 patients have leakage and they use a condom urinal. In the urinary diversion group all but 2 patients are completely dry and are on intermittent catheterization. The main problem of the initial series was prolapse of the continence nipple, which has been solved by staple fixation of the nipple to the bowel wall and to the ileocecal valve.

Surgical excision of fibrotic plaques and replacement of the defect by grafts may be necessary in advanced Peyronie disease. Synthetic, absorbable mesh for grafting the defect, was used in 6 mongrel dogs. An area of tunica albuginea 1.5 by 2.5 cm was removed from the corpus cavernosum, thus exposing the spongy cavernous tissue. A Dexon mesh of the same dimensions, woven in our laboratory from polyglycolic acid fibers of 308 denier thickness, was sutured to the defect by 3-0 Dexon sutures. The mesh caused hemostasis and the animals' postoperative course was uneventful. Posterection cavernosograms showed no curvature of the penis, bulging of the operative area, or obstruction of the corpora cavernosa. Histologic studies at three weeks, and two, four, and six months after surgery showed complete healing and gradual replacement of the Dexon mesh by fibrous connective tissue.

Zu einem Zeitpunkt, als sich die extrakorporale Stoswellenlithotripsie noch in einem experimentellen und klinischen Versuchsstadium befand, wurde die perkutane Nephrolithotomie als neues Behandlungsverfahren vorgestellt (1). Bei mangelnder allgemeiner Verfugbarkeit von Stoswelleneinrichtungen konnte sie sich in der Folgezeit als alternatives Behandlungsverfahren zur offenen operativen Behandlung von Nieren- und Harnleitersteinen weltweit durchsetzen. Ihr derzeitiger Stellenwert mus in Relation zu den Behandlungsmoglichkeiten, die die Stoswellenlithotripsie und auch andere endourologische Masnahmen wie die Ureterorenoskopie bieten, definiert werden.

Doppler sonography for intraoperative localization of the intrarenal arteries combined with B-scan sonography for intraoperative visualization of stones allows complete stone removal via small radial nephrotomies for which clamping of the renal artery is no longer necessary. Since September 1980 we used this technique on 35 patients with staghorn or recurrent calculi. The main advantages of this technique are exact and quick stone localization, minimal loss of renal function owing to preservation of the intrarenal vascular system, and no need for renal ischemia and cooling.

Decisive for urethral closure under stress is an increase in intraurethral pressure. This pressure increase is significantly affected by urethral tonus, passive pressure transmission and reflex pressure transmission. Approximately half of the urethral tonus is produced by the striated sphincter muscles (Rud et al. 1981; Tanagho 1979).

Ten dogs were used for electrostimulation of the sacral roots to improve urethral sphincter closure. To induce and maintain urethral closure in longstanding stimulation, a variety of stimulationpatterns was investigated systematically. With continuous stimulation, the induced sphinctericresponse faded corresponding with the increase in frequency of stimulation applied; but in phasicstimulation with a stimulation/rest ratio of 1:2, strong sphincteric contractions were reproducibleafter each rest interval. If the stimulation bursts were shortened to 30-60 msec, interrupted by an off-time of again twice the duration of the stimulation, unfused sphincteric tetani were induced, resulting in a sinusoidal oscillating closure pressure that did not drop in the prestimulus baselineduring the off-time. A sufficient sphincteric closure pressure could thus be sustained over 1 hour ofuninterrupted stimulation.

Monoclonal antibodies, tumor-specific for renal cell carcinoma (RCC), were produced in Balb/C mice, hyperimmunized with tumor cell suspensions from a histological grade II tumor. Boosting with lectin-immobilized tumor-antigen rendered high yields of specific antibody-producing hybrids. Hybridoma supernatants were screened for specificity using a solid-phase enzyme-linked immunoassay. Testing in parallel for reactivity with tumor tissue and corresponding autologous normal kidney material, only those hybrids producing antibodies exclusively reactive with RCC were propagated, resulting in 4 stable, highly productive subclones. Using the immunoperoxidase staining technique, tissue sections from 97 different RCC specimens and corresponding normal kidneys were evaluated for reactivity with the monoclonal antibodies. Over 90% of RCC were strongly positive, whereas normal kidney tissue did not react. Other normal human organ sections, including pancreas, liver, lung, stomach, small intestine, spleen, lymph node, arteries, veins, skeletal muscle, heart, skin and fetal tissues were negative for tumor-associated antigens. Mucous substances and Panet's granular cells in colon mucosa showed nonspecific binding suppressible by addition of normal human serum. Adenocarcinoma of the stomach, colon, pancreas or breast did not demonstrate cross-reactivity with the antibodies to RCC. These monoclonal antibodies apparently recognize a tumor-associated antigen possibly specific for RCC. They could prove to be potent tools in the search for specific tumor markers applicable in the early diagnosis of the disease and immunotargeting cancer therapy.

Bei einem Gesamtkrankengut von nunmehr 158 Patienten mit Mainz-Pouch und einer Nachbe-obchtungszeit von bislang bis zu 50 Monaten (durchschnittlich 24 Monate) erwies sich das Konzept des ”Niederdruckreservoirs“ mit hoher Kapazitat als zuverlassig und richtig. Frank Hinman’s Prinzipien zur Auswahl von Darmsegmenten zum Blasenersatz [1] hinsichtlich geometrischer Kapazitat, Akkommodation, Compliance und Kontraktilitat werden vom spharischen Ileocoecalpouch in idealer Weise erfullt.