ABSTRACT
Objective To compare split-cuff nipple and direct ureteroileal anastomosis during ureteroileal anastomosis.Methods Between December,2014 and March,2017,a prospective randomized study was conducted on 70 patients who underwent radical cystectomy and urinary diversion.In every patient,both ureters were randomized to be implanted using an antireflux,split-cuff nipple technique (group A) or a reflux,direct technique (group B).After pelvic lymph node dissection and radical cystectomy,a Mshape orthotopic ileal neobladder was constructed and two ureters were implanted with single-J tubes placed for 10-12 days.For split-cuff nipple technique,a 0.5 cm longitudinal incision in the ureter was made,and the ureteral wall was turned back on itself,construction a nipple.The cuff was stabilized at the corners with sutures.The ureter was then placed into the bowel with 0.5 cm nipple.The ureter was sutured to the full thickness of the bowel wall with interrupted 4-0 PDS.For direct technique,a 0.5 cm incision in the ureter was made,the full thickness of the ureter was sewn to the mucosa of the bowel.Results 70 patients were enrolled in the study,63 males and 7 females,(62.5 ± 10.4) years old.Over a median follow-up of 13.2 months,one patients had bilateral anastomosis stricture 3 months after operation,1 patient in group A had stricture 6 months after operation,2 patients in group B had stricture 6 and 12 months after operation,respectively.Six patients (8.6％) in group A found reflux compared with 21 patients (30.0％) in group B (P =0.004).The reflux pressure was (23.5 ± 9.0) cmH2O and (15.5 ± 4.9) cmH2O in group A and group B (P =0.042),respectively.The GFR of group A was (38.1 ± 7.6) ml/min compared with (38.6 ± 12.9) ml/min in group B at 12 months after operation.One patient in group A and four patients in group B had acute nephropyelitis.Four patients in group A had renal stones formation compared with 1 patients in group B.The time of anastomosis was (8.8 ± 3.5) minutes and (6.7 ± 1.5) minutes (P =0.037) for group A and group B,respectively.The patients in both groups had no urine leakage.Conclusion Compared with direct technique,split-cuff nipple technique had lower reflux rate,higher antireflux pressure and longer anastomosis time than direct technique.
ABSTRACT
PURPOSE: The Mitrofanoff continent catheterizable stoma is a useful technique in continent reconstruction. Continence is dependent on the formation of a valve mechanism usually in the form of a submucosal tunnel. This mechanism requires careful dissection of the appendix mesentery and may not be appropriate in small bowel pouches, The split cuff nipple technique has been used effectively for ureteral reimplantation into bowel segments, This paper describes the successful combination of these techniques to provide a continent catheterizable stoma. MATERIALS AND METHODS: Five patients(6 cases) have undergone split cuff nipple stoma formation. Appendix was used in 5 cases and ileum was used in 1 case. Underlying disease were 3 bladder cancers and 2 spinal cord injuries. Reservoir was made using 3 patients ileum, 1 right colon and 1 ileocolon. In 3 cases the appendix was brought out through the umbilicus and in another 3 cases the stoma was formed in the right iliac fossa. CONCLUSIONS: The split cuff nipple appendix stoma provides a simple and reliable continent stoma technique, overcoming some of the complexities of reimplantation of the intact appendix. The technique may be suitable for other narrow tubes, mainly the stapled small bowel or gastric tube.