Simplified Uretero-Intestinal Implantation in Continent Cutaneous Urinary Diversion Using Ileovalvular Segment as Afferent Loop and Appendix as Continent Outlet

Abstract

PURPOSE: We performed continent cutaneous urinary diversion with implantation of ureters as in ileal loop diversion to reduce the risk of ureterointestinal implantation stricture. MATERIALS AND METHODS: Four patients underwent colonic pouch and 11 underwent ileocecal continent urinary diversion the ileocecal segment used as an afferent loop and the sphincter-like function of the ileocecal valve used as an antireflux mechanism. RESULTS: All preoperatively undilated renal units (26 of 30) remained postoperatively undilated. Of the 4 preoperatively dilated renal units 3 also showed postoperatively improvement (mean followup 8 months). However, after 3 to 14 months transient reflux occurred during contraction waves in the reservoir in 6 renal units. CONCLUSIONS: Our modified technique simplifies ureteral reimplantation and appears to diminish the postoperative complication of anastomotic structure. The solution to the problem of occasional reflux may be reinforcement of the ileocecal valve.