Continent vesicocutaneostomy. Preliminary experiments on dogs

Abstract

A new operative technique for continent urinary diversion was designed as a continent vesicocutaneostomy and preliminary experiments were performed on 7 dogs. A U-shaped flap of anterior bladder wall (30 X 20 X 30 mm) was created, which was then rolled and sutured to an efferent duct. One-half to two-thirds in length of the efferent duct was placed between the muscular layer and mucosa of the bladder, and the distal end of the efferent duct was anastomosed to the cutaneous stoma made at the suprapubic area. In this urinary diversion, excretion of urine from the bladder was done by intermittent catheterization from the stoma through the efferent duct. The operation was successful on all of the experimented dogs, continence of the stoma was preserved and catheterization through the stoma was achieved easily. Urodynamic assessment of the efferent duct was performed, being focused on the mechanism of continence, at 3 and 6 months after the operation. The length of continence zone and maximum closing pressure through the entire efferent duct were 23.2 +/- 4.5 mm and 41.2 +/- 14.7 cmH2O respectively with empty bladder (intravesical pressure = 0). When the bladder was full (intravesical pressure = 20-40 cmH2O), these parameters were 21.4 +/- 4.7 mm and 36.0 +/- 7.0 cmH2O respectively. The length of continence zone and maximum closing pressure of only the submucosal part of the efferent duct were 12.8 +/- 4.3 mm and 18.5 +/- 5.2 cmH2O with empty bladder, 13.3 +/- 2.9 mm and 22.0 +/- 9.9 cmH2O with full bladder.(ABSTRACT TRUNCATED AT 250 WORDS)