The Hydraulic Antireflux Valve: A New Technique for Reimplanting Dilated Ureters

Abstract

Purpose: Wide ureters have a high risk of urinary reflux if they are implanted in the intestinal segment. Since 1978, we used the continence hydraulic valve as an antireflux device without staples.Materials and Methods: A total of 40 patients, 20–65 years old (mean age 50), 36 with bilaterally severely dilated ureters and 4 with unilaterally dilated ureters underwent reconstructive surgery by intestinal segments with a hydraulic antireflux valve (HAV).Results: Mean follow–up was 62 months (range 14–110); upper tract dilatation had improved or stabilized in all patients but one in whom bilateral dilatation occurred with HAV stenosis. All patients underwent follow–up loopogram studies which revealed 2 cases of reflux (4 ureterorenal units). In 1 of the 2 patients the urinary reflux occurred after dessusception (disinvagination) of the nipple.Conclusions: The HAV is a safe and reliable procedure in preventing reflux when implanting wide ureters into intestinal segments. This technique can be used in continent urinary diversions with intestinal pouches, and can also be used at the proximal level of an ileoureteroplasty. There is no need for staples.