Evaluation of flap valve as an alternative continence mechanism in the Florida pouch

Objectives. To evaluate urodynamic findings in a successful flap valve (FV) continence mechanism in association with a continent: colonic urinary rese rvoir (Florida pouch) and to compare the urodynamic findings of the RI mech anism with the doubly plicated (PI) standard anti-incontinence segment in t he same reservoir, Methods. Thirteen patients who successfully received the Florida pouch betw een 1988 and 1996 agreed to undergo urodynamic evaluation as part of a pilo t study. Eight patients had a PI continence mechanism and a mean time from surgery of 51 months; 5 had a RI continence mechanism and a mean time from surgery of 14 months. Enterocystometry was performed with a trans-stomal Ba rd triple channel 7F catheter. Volume and pressure at first desire to empty (VFDE, PFDE), as well as maximal enterocystometric capacity and pressure ( VMEC, PMEC), were recorded. Maximal outlet pressure (MOP) was recorded usin g the catheter withdrawal technique, Results, PI and FV groups demonstrated the following mean values respective ly: VFDE, 692.7 and 403 mL; PFDE, 19.5 and 29.2 cm H2O; VMEC, 876.5 and 515 mL; PMEC, 25.9 and 24.6 cm H2O; MOP, 57.5 and 51.2 cm H2O (reservoir empty ) and 50.5 and 52.6 cm H2O (reservoir full); and functional length of outle t, 24.3 and 24.6 cm. MOP measurement demonstrated greater variability in th e PI than in the RI group. Conclusions. Urodynamic comparison of these mechanisms reveals that MOP mea surement was closer to the mean among FV than PI patients. In addition, the mean VFDE (692.7 mt for PI versus 403 mt for RI, P < 0.05) and the mean VM EC (876.5 mt for PI versus 515 mt for RI, P < 0.05) were significantly less in the FV group. Lower VMEC and less variability in MOP indicate that cont inence may be more dependent on MOP in the FV mechanism. A longer follow-up time and a larger number of patients will be of assistance in clarifying t hese findings. (C) 1999, Elsevier Science Inc. All rights reserved.