STABILIZATION OF THE NIPPLE BASE WITH TITANIUM RINGS WHEN REOPERATINGPATIENTS WITH CONTINENT UROSTOMIES FOR NIPPLE DYSFUNCTION

Nipple dysfunction in Kock reservoirs used for continent urinary diver sion is usually caused by a flattening out of the intestinal nipple du e to a lateral tore at the base of the nipple when the reservoir expan ds. This study describes a new method to repair dysfunctioning nipples based on the use of titanium rings applied outside the reservoir arou nd the base of the nipple. Experiments on dogs and rats have shown tha t rings and plates of titanium rapidly attach to the serosal surface o f ileum exposed to urine with only minor signs of inflammation. Ten pa tients with Kock reservoirs for urinary diversion have been reoperated for nipple dysfunction due to nipple sliding with elongation of the n ipple and fixation of the nipple base with titanium rings. The functio nal result is excellent in 9 out of the 10 patients. No signs of erosi on of the rings into the reservoirs have been noted. With this new met hod for nipple repair the need for using more intestine to construct a new nipple is eliminated.