Urinary Diversion To The Augmented and Valved Rectum an Experimental Study in Dogs

Abstract

A new model for diverting urine to the rectum was tried in dogs. An intussusception valve was constructed at the junction of the sigmoid colon and the rectum allowing passage only in aboral direction. The rectum was augmented by patching it with an opened and folded ileal segment. The ureters were implanted into the rectum by a new anti-reflux method. All three dogs survived the operation. The volume of the augmented rectum increased from 80-150 ml at operation to a maximum of 750 ml six months after the operation. The pressure in the rectum did not exceed 18 cm of water during maximal filling. No reflux to the bowel proximal to the intussusception valve or to the ureters could be observed even during maximal filling of the augmented rectum. No signs of obstruction of the fecal stream by the intussusception valve were seen. In three out of five implanted renal units strictures developed at the implantation sites and resulted in impaired renal function. In the two renal units without strictures, no impairment of kidney function was found. Involuntary leak from the anus was not observed and no masceration was found around the anus. These experiments are regarded as very encouraging an a clinical trial is now under way.

Modified ureterosigmoidostomy (Mainz II) — technique and early results

“…In two patients, a modification of the technique described by Kock et al [ 5] was used. The same 20 cm of lower rectum and sigmoid were identified, the bowel opened longitudinally and augmented with a patch of ileum, after the ureters had been implanted.…”

Three-dimensional computed tomography of the reconstructed lower urinary tract: technique and findings

“…1, 2) with anti-reflux nipple (35 males and 14 females) [3] and 1 male without anti-reflux nipple [4], 3 with a ureteroileal rectosigmoidostomy (2 males and 1 female) [5], and 1 male with an ileum augmentation of a rectum bladder [6].…”

A comparative study of the effects of a colorectal valve on the oro‐anal transit time in patients with an augmented and valved rectum for urinary diversion

“…The colorectal valve limits the colonic absorptive surface by functionally isolating the rectal reservoir; it prevents the regurgitation of rectal contents to the rest of proximal colon. Moreover, both experimental and clinical studies showed an unimpeded flow of colonic contents distally to the rectal reservoir and through the constructed intussuscepted valve [ 8–10].…”

“…These differences probably arose from the reduction in the surface area available for reabsorption when a valve is constructed. Moreover, the valve, being isoperistaltic, caused no impedance in the passage of the colonic fecal contents to the rectal reservoir [ 6–10]. However, it is important to verify that the augmented and valved rectum does not affect intestinal motility and the present study was conducted to address this issue for the colorectal valve.…”