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

Abstract

Objective To examine the feasibility of using the serouslined-tunnel principle for orthotopic neobladder, continent cutaneous diversion and ureteric replacement by an intestinal segment. Patients and methods We created: (i) an orthotopic ileal neobladder using the serous-lined technique for antire¯uxing ureteric implantation in 16 patients; (ii) a continent ileal pouch, adopting the principle for continent-valve construction and for ureteric implantation, in 10 patients (another patient 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 antire¯uxing mechanism was constructed in two patients (with lower ureteric cancer), and total replacement of the ureter by a tubular segment of the colon in association with a continent transverse colon pouch in one irradiated patient.Results In all, 52 ureters implanted into ileal neobladders or continent pouches functioned well, with neither obstruction nor re¯ux; 11 continent valves functioned well with no incontinence. Two patients with ileal ureters showed no ileo-ureteric re¯ux and had less hydronephrosis than before surgery. The tubularized ureter provided a unidirectional¯ow into the pouch. Conclusion Ureteric reimplantation and continent valve formation achieved by 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 serouslined tunnel principle should be possible in urinary reconstruction.

Uretero‐intestinal anastomosis in low‐pressure reservoirs: refluxing or antirefluxing?

“…The feasibility of this procedure was initially tested in an animal model [23] and was followed by its clinical application. Our results, and those reported by others, are summarized in Table 3[10,16,24–34]. The rate of anastomotic strictures was 0–9% while that of reflux was 0–11%.…”

Comparison between a serous‐lined extramural tunnel and T‐limb ileal procedure as an antireflux technique in orthotopic ileal substitutes: a prospective randomized trial

“…Later, they reported their further clinical experience with a large group of patients, and maintained several advantages of the technique with a low anastomotic stricture rate of 3.8%[19]. The technique was popularized and reported by several centres worldwide, keeping the low (0–4%) stricture rate [5,20–22] even in a long‐term analysis [23,24]. Notably, only two studies reported higher stricture rates on using this technique [12,25].…”

Εκτροπή Των Ούρων Με Εγκρατή Ορθοσιγμοειδική Νεοκύστη

“…Οι παραπάνω χειρουργοί Ουρολόγοι, μετά από μία σειρά πειραματικών ερευνών σε σκύλους [58,59,60], εφάρμοσαν την τεχνική τους σε ασθενείς με ενθαρρυντικά στην αρχή αποτελέσματα [61], γεγονός που τους ώθησε να συνεχίσουν την προσπάθειά τους σε μεγαλύτερο αριθμό ασθενών με πολύ καλά αποτελέσματα [62]. Ετσι σε σύντομο χρονικό διάστημα κατάφεραν να καθιερώσουν την τεχνική τους, η οποία έγινε αποδεκτή και από άλλους Ευρωπαίους και Αμερικανούς Ουρολόγους [63,64,65,66,67].…”