Wall-incorporated antireflux valve in ileal bladder substitutes: first clinical experience in 17 patients

Abstract

Objectives. To report on the initial clinical results of a novel technique of a wall-incorporated antireflux valve in ileal urinary reservoirs. Methods. Forty-five centimeters of the terminal ileum were isolated. A double-folded pouch was created using the distal 42 cm, of which the distal 35 cm was detubularized and the proximal 7 cm was left intact to act as a valve. Suturing at the borders of the valve was performed so that the valve formed part of the pouch wall. The technique was carried out in 17 patients. The mean follow-up period was 24 months (range 12 to 44). The patients were evaluated clinically and radiologically. Endoscopic examination was carried out in 3 patients. Results. None of 17 patients showed reflux on ascending cystography. Excretory urography revealed stable or improved upper tracts in 33 renal units. Hydroureteronephrosis was found in one unit because of ureteroileal stenosis that required operative correction. All patients were continent during the day. Night wetting occurred in 2 patients; imipramine hydrochloride therapy resulted in a complete response in 1 patient and partial improvement in the other. Conclusions. The preliminary results of wall-incorporated antireflux valve are encouraging. It is technically simple and easy. It is not time consuming and requires a shorter ileal segment than that required for the intussuscepted valve. Staples are not used. The vascular pedicle is not manipulated. The wall-incorporated valve is suitable for the normal, dilated, or short ureter. Despite limited clinical experience, the valve may provide a reliable technique for reflux prevention in bladder substitutes.