The serous-lined tunnel principle for urinary reconstruction: a more rational method

Objective To examine the feasibility of using the serous-lined-tunnel princ iple for orthotopic neobladder, continent cutaneous diversion and ureteric replacement by an intestinal segment. Patients and methods We created: (i) an orthotopic ileal neobladder using t he serous-lined technique for antirefluxing ureteric implantation in 16 pat ients: (ii) a continent ileal pouch, adopting the principle for continent-v alve construction and for ureteric implantation, in 10 patients (another pa tient with a failed continent valve underwent revision using an adaptation of this principle; and (iii) by applying the same principle an ileal ureter with a proximal antirefluxing mechanism was constructed in two patients (w ith lower ureteric cancer), and total replacement of the ureter by a tubula r segment of the colon in association with a continent transverse colon pou ch in one irradiated patient. Results In all, 52 ureters implanted into ileal neobladders or continent po uches functioned well, with neither obstruction nor reflux; 11 continent va lves functioned well with no incontinence. Two patients with ileal ureters showed no ileo-ureteric reflux and had less hydronephrosis than before surg ery. The tubularized ureter provided a unidirectional now into the pouch. Conclusion Ureteric reimplantation and continent value formation achieved b y adopting the serous-lined tunnel principle provided satisfactory results. The versatility of the principle is apparent in the present experience and the creative application of the serous-lined tunnel principle should be po ssible in urinary reconstruction.