THE FAILED ANTI-INCONTINENCE MECHANISM - A FLAP VALVE OR CECAL WRAP FOR SURGICAL RECONSTRUCTION

Purpose: On a long-term basis patients with continent urinary diversio ns may have an acceptable number of complications, such as urinary inc ontinence. We report on a new surgical technique for treatment of the incompetent anti-incontinence segment. Materials and Methods: Seven pa tients presented with a large capacity, low pressure reservoir and an incompetent anti-incontinence mechanism. The original anti-incontinenc e mechanism consisted of an intussuscepted reimplanted appendix (Mitro fanoff) in 2 patients, tapered ileum and reinforced ileocecal valve in 3, and tapered and reimplanted ileal segment in 2. Surgical reconstru ction involved 2 stages: stage 1-lengthening and tubularizing the cecu m with the anti-incontinence segment and stage 2-creation of the flap valve mechanism. Stage 2 required intraoperative modification when abu ndant peri-reservoir fibrosis, a thin-walled reservoir (cecal wrap) or an excessive thickened mesentery was encountered. Results: After a me an followup of 7 months 6 of 7 patients performed catheterization ever y 4 hours and were continent. Several patients required a concomitant procedure with the incontinence revision. Conclusions: We describe a 2 -stage technique for correction of a variety of untoward anatomical co nditions related to a failed anti-incontinence segment with continent urinary reservoirs. Concomitant repair of other coexisting structural abnormalities related to the continent reservoir may also be necessary .