A WALL-INCORPORATED VALVE FOR PRESERVING CONTINENCE - AN EXPERIMENTALEVALUATION OF A NEW TECHNIQUE

Objective To describe a new continent valve incorporated as part of th e wall of a urinary reservoir constructed from bowel. Materials and me thods The technique was evaluated experimentally in 12 dogs; 40 cm of the distal ileum were isolated and the proximal 30 cm detubularized. T he adjacent distal 7 cm of the intact ileum (valvular segment) was tai lored around an 18 F catheter, The opened ileum plus the valve were do ubly folded to form a pouch and the valvular segment incorporated as p art of the pouch wall. The pouch was anastomosed to the trigone after subtotal cystectomy; the ureters were not manipulated. The pressure pr ofile of the valve and ascending cystography were assessed 20 weeks af ter surgery and the inner layer of the valve examined histopathologica lly after the animals were killed. Results None of the 12 dogs showed leakage through the valve at maximum filling on ascending cystography, The urodynamic assessment verified the reliability of the valve in ma intaining continence and there were no problems catheterizing the valv e. The histopathological examination showed that the valve was covered by intestinal mucosa. Conclusions The new continent valve is technica lly easy to construct; the procedure is not time-consuming, staples ar e unnecessary and the mesenteric vascular pedicle is not manipulated. A shorter ileal segment is used in constructing this valve than is req uired for the intussuscepted valve. The wall-incorporated valve seems to provide a reliable and easily catheterizable continent stoma.