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The serous‐lined tunnel principle for urinary reconstruction: a more rational method
Author(s) -
Kato H.,
Kiyokawa H.,
Igawa Y.,
Nishizawa O.
Publication year - 2001
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.2001.02229.x
Subject(s) - ureter , medicine , serous membrane , pouch , serous fluid , urinary diversion , surgery , reflux , hydronephrosis , urology , urinary system , cystectomy , anatomy , bladder cancer , cancer , disease
Objective To examine the feasibility of using the serous‐lined‐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 antirefluxing 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 antirefluxing 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 reflux; 11 continent valves functioned well with no incontinence. Two patients with ileal ureters showed no ileo‐ureteric reflux and had less hydronephrosis than before surgery. The tubularized ureter provided a unidirectional flow 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 serous‐lined tunnel principle should be possible in urinary reconstruction.