A wall-incorporated valve for preserving continence: an experimental evaluation of a new technique.

Abstract

Objective: To describe a new continent valve incorporated as part of the wall of a urinary reservoir constructed from bowel.

Materials and methods: The technique was evaluated experimentally in 12 dogs; 40 cm of the distal ileum were isolated and the proximal 30 cm detubularized. The adjacent distal 7 cm of the intact ileum (valvular segment) was tailored around an 18 F catheter. The opened ileum plus the valve were doubly folded to form a pouch and the valvular segment incorporated as part of the pouch wall. The pouch was anastomosed to the trigone after subtotal cystectomy; the ureters were not manipulated. The pressure profile of the valve and ascending cystography were assessed 20 weeks after surgery and the inner layer of the valve examined histopathologically after the animals were killed.

Results: None of the 12 dogs showed leakage through the valve at maximum filling on ascending cystography. The urodynamic assessment verified the reliability of the valve in maintaining continence and there were no problems catheterizing the valve. The histopathological examination showed that the valve was covered by intestinal mucosa. The new continent valve is technically easy to construct: the procedure is not time-consuming. staples are unnecessary and the mesenteric vascular pedicle is not manipulated. A shorter ileal segment is used in constructing this valve than is required for the intussuscepted valve. The wall-incorporated valve seems to provide a reliable and easily catheterizable continent stoma.