SIMPLE ANTIREFLUX VALVE IN ILEAL BLADDER SUBSTITUTES - AN EXPERIMENTAL-STUDY IN DOGS

Objectives. To provide a simple, reliable, and easy antireflux valve i n ileal bladder substitutes. Methods. Forty centimeters of the termina l ileum were isolated. A double-folded pouch was formed using the dist al 37 cm, of which the proximal 7 cm were left intact to act as a valv e. The remaining distal 30 cm were detubularized. Suturing at the bord ers of the valve was performed through linear seromuscular grooves cre ated by diathermy burn. The ureters were anastomosed end-to-side to th e supravalvular segment. The pouch was anastomosed to the trigone afte r subtotal cystectomy. The technique was carried out in 10 female mong rel dogs. All dogs were evaluated by ascending cystography and excreto ry urography at 12 and 20 weeks. Autopsy and histopathologic examinati on of the valve were carried out after the animals were killed at 20 w eeks. Results. None of the 10 animals showed ureteral reflux in ascend ing cystography. Excretory urography revealed a perfect upper tract ex cept in a dog that showed bilateral hydroureteronephrosis due to bilat eral ureteroileal stenosis. Conclusions. This new valve is technically simple and easy. The procedure is not time consuming, and staples are not required. The vascular pedicle is not manipulated. A shorter ilea l segment is used in this type of valve construction in comparison wit h that required for the intussuscepted valve. This valve appears to be reliable for reflux prevention in ileal bladder substitutes.