Simple anti-reflux uretero-ileal anastomosis: An experimental study in dogs

Purpose: To develop more simple and effective anti-reflux techniques applic able to the ileal reservoir, we examined the usefulness of a novel anti-ref lux uretero-ileal anastomosis creating a flap valve mechanism. Materials and Methods: Five dogs were used. A 4 cm. long ileal segment was isolated and its oral part (2.5 cm.) was detubularized. The detubularized i leal plate was anastomosed to the dome of the bladder. The left ureter was cut and its proximal end was spatulated and anastomosed end-to-side to the ileal plate. The end of the 1.5 cm. long afferent limb (non-detubularized p art of the ileal segment) was closed and fixed down to the ileal plate to c reate an extramural tunnel. In this way, the reimplanted ureter was covered by the afferent limb. The dogs were evaluated between 3 and 4 months posto peratively. Results: None of the 5 dogs used showed vesico-ureteral reflux or hydroneph rosis. Histological examination showed an intact ureter enclosed with a nor mal ileal wall. Conclusion: Our proposed anti-reflux uretero-ileal anastomosis is simple an d reliable. This technique may be suitable for applying to a urinary reserv oir, especially as an alternative to the intussuscepted nipple valve.