EVOLUTION OF OUTCOMES WITH THE ILEAL HYDRAULIC VALVE CONTINENT DIVERSION - REEVALUATION OF THE BENCHEKROUN CATHETERIZABLE STOMA

Initial reports with limited follow-up suggested that the ileal hydrau lic valve was a satisfactory approach to continent urinary diversion t hat was associated with acceptable early complication rates and unifor m efficacy in achieving continence. We sought to evaluate the later ou tcomes of patients with this form of continent urinary diversion. An a verage extended follow-up of 5 years was available on 11 patients who had undergone ileal hydraulic valve diversion. Although only 13% of pa tients had complications requiring surgical revision at 18 months of f ollow-up, at the 5-year follow-up, 91% had developed complications req uiring surgical revision. Of these, 64% entailed major revision of the urinary diversion. The most common late complication was stomal steno sis (73%); calculus formation (36%) and devagination (36%) were also c ommon. Although in some cases, stomal stenosis was successfully manage d by superficial revision with skin flaps and grafts, most cases requi red complete replacement of the efferent limb. Use of the devaginated or stenosed ileal hydraulic valve to construct a flap-valve efferent l imb based on the Mitrofanoff principal succeeded in salvaging the cont inent urinary diversions in these patients. Novel forms of urinary div ersion require extended follow-up for accurate assessment of their fea sibility and efficacy. Attentive surveillance with surgical revision a s necessary in such cases is mandatory for the preservation of contine nce and renal function.