Laparoscopic evaluation of two different anti-reflux techniques of uretero-intestinal anastomosis: metabolic impact

Split-nipple [n=10] and the submucosal tunnel [n=10] antireflux uretero-intestinal anastomotic techniques were performed employing 12 female pigs with average weight ranging from 35 to 40 kg. Preoperative intestinal preparation, both chemical and mechanical, was achieved 48 hours prior to surgery. Renal panel was also performed for all animals pre- and postoperatively. A 5-port trans-peritoneal technique was employed. The procedure comprised bilateral dissection of the ureters, hemicystectomy, isolation of a 20 cm ileal segment, ureter-intestinal anastomosis and ileo-cystoplasty. Animals were followed up for a period ranging from two weeks to three months. Bilateral antireflux uretero-ileal anastomoses were completed in all 10 animals with average total operative time of 4.5 hours and mean blood loss of 40 ml. All technical maneuvers could be performed completely intracorporealy using laparoscopic techniques. Mean pre- and postoperative serum creatinine was 1.1 and 1.2 mg%, respectively. All animals were non refluxing, however, two of the split-nipple uretero-ileal anastomosis had ureteral strictures. There were no significant metabolic effects of using intestinal segments in this procedure

Long-Term results of clean intermittent catheterization

The aim of this study was to determine the outcome of clean intermittent catheterization [CIC] and the prevalence of associated urinary tract problems in patients who had been using the technique for a long time. This study included 94 patients [88 men and 6 women] whose mean age +/- SD was 38 +/- 18.2 years and the mean duration of using clean intermittent catheterization [CIC] was 11 years [range 7-13 years]. Based on the results of urodynamics, the patients were divided into two groups: Group I comprised 68 patients with hyperreflexic bladder, dyssynergic external sphincter and high post-void residual urine and group II comprised 26 patients with an underactive detrusor. At the end of follow-up period, the patients were evaluated and the two groups were compared for continence, bacteriuria, symptomatic urinary tract infections, upper tract changes and other complications related to the procedure. Clean intermittent catheterization is a safe and effective method for managing patients with different voiding dysfunction