A SEROUS LINED ANTIREFLUX VALVE - IN-VIVO FLUOROURODYNAMIC EVALUATIONOF ANTIREFLUX CONTINENCE MECHANISM

We evaluate the fluoroscopic and urodynamic performance of a new seros al lined antireflux continence valve (T pouch valve) using an in vivo animal model. Materials and Methods: Intestinal reservoirs were constr ucted using an in vivo pig model. Multiple serosal lined valves of var ying diameters and tunnel lengths were evaluated in the acute (immedia tely after construction) and chronic (4 weeks postoperatively) setting s. Video fluorourodynamic evaluations were performed to identify valve leak point pressures and optimal tunnel length-to-luminal diameter ra tios. Results: Four serosal lined valves tapered to a diameter of 18 a nd 30F in 1 and 2 cm. tunnels were evaluated. Immediately following co nstruction of the valves no leakage was observed during reservoir fill ing (maximal pressure 50 cm. water) or external compression maneuvers to simulate a Valsalva maneuver (maximal intra-reservoir pressure 100 cm. water). Identical fluorourodynamic studies performed after a 4-wee k recuperation demonstrated leakage through the 30F, 1 cm, tunnel valv e during reservoir filling (intra-reservoir pressure 19 cm. water). In creasing the tunnel length of the 30F system to 2 cm. (tunnel length-t o-luminal diameter ratio 2:1) eliminated all evidence of valve leakage up to a maximal intra-reservoir pressure of 100 cm. water. Conclusion s: These studies demonstrate the urodynamic characteristics of a new s erosal lined valve. This easily constructed mechanism serves as a reli able antireflux (afferent) or continence (efferent) system.