Continent cutaneous ileal pouch using the serous lined extramural valves. the mansoura experience in more than 100 patients
Abstract
PURPOSE: We report on the functional results of continent ileal reservoir using serous lined extramural valves for reflux prevention and continent urinary outlet. MATERIALS AND METHODS: The procedure was performed in 109 patients (68 men, 27 women and 14 children). The operation was indicated as a primary procedure in 93 patients and for conversion in 16. The technique entailed construction of a detubularized W-shaped ileal reservoir in which 2 serous lined troughs were created. Two tapered ileal segments were used, 1 for reflux prevention and the other as a continent outlet. The appendix was used for the construction of the outlet in 44 patients. RESULTS: Two patients died in the hospital of pulmonary embolism. A total of 22 early complications were observed in 18 patients (16.5%). None of the patients required operative intervention. A total of 93 patients were evaluable with a mean followup of 36.6 +/- 25.4 months. All evaluable patients but 5 were continent day and night. Mean time for catheterization was 4 to 5 hours. There were 14 late complications reported in 11 patients (11.8%), including pouch stones in 5, stomal stenosis in 5, failure to catheterize in 2, parastomal hernia in 1 and adhesive bowel obstruction in 1. Upper urinary tract was stable or improved in 94.8% of the renal units. Clinical acidosis did not develop in any of the patients. CONCLUSIONS: Serous lined unidirectional valves are reliable. They provide a versatile surgical technique suitable for…
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