Continent Urostomy with Hydraulic Ileal Valve in 136 Patients: 13 Years of Experience

Abstract

The hydraulic ileal valve, which we developed in 1975, ensures continence by adapting to 5 different urinary reservoirs. The valve is made by isolating a 14 cm. long intestinal loop with the mesentery. The isolated ileal segment then is folded inward on itself throughout its entire length. We performed 136 continent urostomies with this hydraulic valve. An ileocecal reservoir was used in 122 patients, ileum in 8, sigmoid in 1, rectum in 1 and bladder (continent cystostomy) in 4. Indications for continent urostomy were bladder tumor in 55 patients, complex vesicovaginal fistulas in 5, neurogenic bladder in 13, vesical exstrophy in 12 and miscellaneous reasons in 5. Of the patients 103 (75 per cent) were continent immediately. Continence was obtained after repair of the valve in 24 patients (17.6 per cent). Therefore, 127 patients over-all were continent. Mean followup of our patients was 38 months (range 3 to 154 months). Continence remained excellent with self-catheterization performed easily in 88.3 per cent of the patients. Over-all, all of our continent urostomies were well tolerated biologically and radiologically.

Functional Bladder Replacement after Radical Cystectomy in the Female: Experimental Investigation of a New Concept

“…Despite the social and psychologi cal disadvantages of urinary drainage into an external reservoir, this method remains standard today. Prompted by the work of Kock and Skinner et al [4,5], great interest is now being shown in bladder replacement with detubularized sections of intestine [4][5][6][7][8][9][10]. The creation of a lowpressure reservoir with sufficient capacity and an antirefluxive implantation of the ureters into the pouch assures continence over longer periods, without putting the upper urinary tract at risk.…”

Evolution of outcomes with the ileal hydraulic valve continent diversion: reevaluation of the Benchekroun catheterizable stoma

“…Close inspection, however, reveals that such favorable ultimate outcomes are often achieved in a setting where intercurrent complications arise in the continent urinary diversion. Close surveillance, mandatory in management of the continent urinary reservoir, can lead to early recognition of such adverse developments and the surgical correction thereof.The present authors and other investigators have previously reported on the early outcomes of the urinary-pressure valve efferent continent reservoir limb, based on the initial work of Benchekroun et al [1,6,11,16]. Early results indicated a potential advantage for this approach as compared with other forms of continent diversion [6,11].…”

“…The present authors and other investigators have previously reported on the early outcomes of the urinary-pressure valve efferent continent reservoir limb, based on the initial work of Benchekroun et al [1,6,11,16]. Early results indicated a potential advantage for this approach as compared with other forms of continent diversion [6,11].…”

“…A separate ileal segment or one in continuity with the ileocolic reservoir was used to construct the hydraulic continence mechanism according to the technique described by Benchekroun et al [1]. With this technique, 12-14 cm of ileum was isolated on its mesentery.…”

Construction of a Continent Catheterizable Urinary Valve from a Gastric Segment in Dogs

“…How ever, the intended continence of the valve cannot be achieved in some patients [7][8][9][10][11], Besides, the ileum may be unavailable to construct a valve when the patient has a history of irradiation over the lower abdomen. The con struction of a continent valve using a gastric segment is considered to be an alternative for such patients.…”