ABSTRACT
Objective To investigate the feasibility of an ileal reservoir with self controllable urination. Methods A segment of ileum was under taken,the middle portion of which was made into a N shaped reservoir and the proximal portion used as the afferent limb.The distal ileum was pulled out and the two skin flaps were taken and encircled the efferent ileum to constitute the urinary outflow.A urinary controller similar to penile clamp was applied to control the urination with a balloon catheter. Results Ten dogs and five patients underwent this procedure and the patients were followed up for 3 to 14 months.Urodynamic examination showed that on the third month,the reservoir in animals reached a maximum capacity of (150?40)ml and a full filling pressure of (24.4?5.3)cmH 2O.The reservoir in the patients reached a maximum capacity of (290?80)ml,a full filling pressure of (36.3?8.2)cmH 2O,a maximum urinary flow rate of (20.3?4.7)ml/s with no residual urine.X ray examination showed good excretory function of the kidney without hydronephrosis.All patients can control urination themselves through the use of the urinary controller. Conclusions The new procedure has the advantages of self control lable of urination,simple surgical performance and few complications.
ABSTRACT
A new method of urinary diversion via Skinner`s modification of Koch continent ileal reservoir was tried. With this method continence with storage of urine under low pressure is well maintained so that no external applicances are necessary. Ileorenal reflux is also prevented with this nipple forming technique. From May l986 to September l986, 4 patients underwent urinary diversion that included creation of a modified Koch pouch by Skinner. Previous urinary diversion was by ureterocutaneous diversion in 1 patient. A total of 3 patients underwent radical cystectomies for bladder cancer In 1 patient, simultaneous urethrectomy was done because of carcinoma in situ in the urethra. There were no operative mortalities. All patients are continent and without reflux to the upper urinary tract. The volume capacity of pouch is more than 400ml. The pouch is emptied by self-catheterization every 4 to 6 hours during the day and once at night. Postoperative follow-up presently is short and it is impossible to check late complications. Although preliminary, this clinical trial suggests that the quality of life for patients can be improved markedly by the modified Koch continent ileal reservoir.