WALL-INCORPORATED ANTIREFLUX VALVE IN ILEAL BLADDER SUBSTITUTES - FIRST CLINICAL-EXPERIENCE IN 17 PATIENTS

Objectives. To report on the initial clinical results of a novel techn ique of a wall-incorporated antireflux valve in ileal urinary reservoi rs. Methods. Forty-five centimeters of the terminal ileum were isolate d. A double-folded pouch was created using the distal 42 cm, of which the distal 35 cm was detubularized and the proximal 7 cm was left inta ct to act as a valve. Suturing at the borders of the valve was perform ed so that the valve formed part of the pouch wall. The technique was carried out in 17 patients. The mean follow-up period was 24 months (r ange 12 to 44). The patients were evaluated clinically and radiologica lly. Endoscopic examination was carried out in 3 patients. Results. No ne of 17 patients showed reflux on ascending cystography. Excretory ur ography revealed stable or improved upper tracts in 33 renal units. Hy droureteronephrosis was found in one unit because of ureteroileal sten osis that required operative correction. AII patients were continent d uring the day. Night wetting occurred in 2 patients; imipramine hydroc hloride therapy resulted in a complete response in 1 patient and parti al improvement in the other. Conclusions. The preliminary results of w all-incorporated antireflux valve are encouraging. It is technically s imple and easy. It is not time consuming and requires a shorter ileal segment than that required for the intussuscepted valve. Staples are n ot used. The vascular pedicle is not manipulated. The wall-incorporate d valve is suitable for the normal, dilated, or short ureter. Despite limited clinical experience, the valve may provide a reliable techniqu e for reflux prevention in bladder substitutes. (C) 1998, Elsevier Sci ence Inc. All rights reserved.