ANTIREFLUX NIPPLES OR AFFERENT TUBULAR SEGMENTS IN 70 PATIENTS WITH ILEAL LOW-PRESSURE BLADDER SUBSTITUTES - LONG-TERM RESULTS OF A PROSPECTIVE RANDOMIZED TRIAL

Purpose: Intestinal low pressure orthotopic bladder substitutes have n o major coordinated contractions during micturition. Therefore, the im portance and type of reflux prevention were assessed in a prospective randomized study. Materials and Methods: A total of 70 patients with a n ileal low pressure bladder substitute was randomized to receive a ni pple valve or an isoperistaltic afferent ileal tubular segment for ref lux prevention. Results: After median observation times of 57 and 45 m onths, respectively, the results regarding functional reservoir capaci ty, incidence of infected urine, urinary continence, voiding habits an d serum electrolytes, urea and creatinine were similar in both groups. Severe upper tract dilatation due to ureteroileal or nipple stenosis occurred in 9 of 67 evaluable reno-ureteral units (13.5%) in patients with antireflux nipples and in 2 of 69 (3%) in patients with an affere nt tubular segment. This difference in favor of the latter cases is si gnificant (Fisher's exact test p < 0.03). Video urodynamics did not sh ow reflux of contrast medium during voiding in either group. A simulta neous intravesical, intra-abdominal and intrapelvic pressure increase was noted during the Valsalva maneuver. Conclusions: While long-term u pper tract preservation by an afferent tubular ileal segment must be c onfirmed in larger patient series with longer followup, our results in dicate that reflux prevention in patients with orthotopic low pressure bladder substitutes is not a major concern and does not justify the u se of antireflux mechanisms with a high complication rate.