A novel antireflux uretero-ileal anastomosis for urinary diversion: an experimental study

Objectives To assess a new antireflux valve technique in a dog model of uri nary diversion, and thus provide a reliable and easily constructed antirefl ux system for an ileal reservoir. Materials and methods In five female beagle dogs, 3 cm of ileum were intuss uscepted into the reservoir formed using the adjacent 10 cm of ileum. The i ntussuscepted ileum was sutured to the reservoir wall after stripping the m ucosa of the reservoir in a trapezoidal zone opposite the similarly strippe d mucosa of the intussuscepted ileum, to avoid dessusception. After the dis tal 4 cm of the ureters was united and pulled through the intussuscepted se gment of ileum, the combined distal ureter was sutured to the labial edge o f the intussuscepted segment. Finally, the reservoir was anastomosed to the bladder as an enterocystoplasty. Dogs were evaluated by ascending cystogra phy and intravenous pyelography at 1 and 6 months. The valve and upper urin ary tract were evaluated histopathologically at 6 months. Results In all dogs the antireflux system remained intact and prevented ref lux. The intussuscepted ileum was firmly attached to the reservoir wall and the submucosa of each segment was united. The upper urinary tract was norm al with no ureteric stenosis. Histopathologically, the ureter was surrounde d by intact ileal serosa and showed no inflammation or scarring. Conclusions The very short ileal segment required and the firm attachment o f the constructed valve to the reservoir were the advantages of this practi cal and reliable new antireflux system.