Construction of a continent outlet using an ileal valve, an in vivo animal model.

Abstract

The efficacy of a new continent outlet mechanism using a simple ileal valve in a continent cutaneous urinary diversion was evaluated. In eight mongrel dogs, a 50 cm distal ileal segment was isolated. The distal 41 cm of the isolated segment was opened along the antimesenteric border while the proximal 9 cm was not detubularized. The distal 6 cm part of the non-detubularized segment was tapered over a 30 F catheter and closed with continuous 3/0 polyglactin sutures. In order to create a valve, this 6 cm tapered ileal segment was wrapped anteriorly by the most distal part of the detubularized ileal segment. The remaining part of the detubularized ileal segment was folded into a U configuration. The posterior plate was completed by joining the limbs of the U with running absorbable sutures. Afterwards, the reservoir was closed by folding the ileal plate in half in the opposite direction to which it was opened. The intact proximal 3 cm part of the isolated ileal segment was brought out to the abdominal skin. A pouchogram of the reservoir and video-urodynamic studies were performed to evaluate the efficacy of the continent outlet 18-20 weeks after surgery. Video-urodynamic studies and pouchograms of the reservoirs revealed no leakage from the continent outlet in any dog. Reservoirs had a mean capacity of 413 +/- 51 ml (range 356-447 ml). When the reservoir was filled to maximum capacity, the average total reservoir pressure was 29 +/- 4.7 cm H2O (range 21-45). This procedure, using a single ileal segment for construction of the continent cutaneous urinary diversion, is simple and safe. The ileal valve mechanism serves as a reliable continent outlet system.