Reinforcing the continent mechanism of continent cutaneous diversions by wrapped rectus abdominis muscle flap :an experimental study / 中华泌尿外科杂志

ABSTRACT

Objective To develop a new continent cutaneous diversion using a tapered ileum wrapped by rectus abdominis muscular flap. Methods Ten dogs underwent a procedure in which two 6 cm ileal segments were tapered and connected to the U-shaped reservoir which was detubularized by a 30-40 cm ileal segment with end-to-side anastomosis. A continent tube was created by a 6 cm length and 3 cm width rectus abdominis muscular flap with its blood supplied which was penetrated be-tween the mesenteric vessels of one tapered ileum (study tube) and wrapped around its periphery. The other tapered ileum (control tube) was brought out into the abdominal skin directly without any extra-mural support. Urodynamic studies were carried out at 1, 3 and 6 months postoperatively. The data of maximum inner pressure (MIP) and functional pressure length (FPL) of every study and control tubes at every study phase were recorded and statistics analysis were taken. Retrograde radiograms of the ef-ferent tubes were performed prior to sacrifice and histological examinations of study group were carried out after sacrificed. Results The average MIP in experimental group was significantly higher than that in control group at 1, 3 and 6 months post-operatively (P<0.01). However, no significant differences in MIP or FPL were found in study group between empty and full reservoir. In the control group, MIP was found rising significantly (P<0.001) and FPL (P<0.05) decreased sharply com-pared with empty and full reservoir. Retrograde radiograms confirmed that all efferent tubes were pa-tent and positioned straightly beneath the abdominal wall. Histological examination of study group at 6 months postoperatively demonstrated a layer of striated muscle around the serosa of the ileum. Conclusions The continent mechanism of tapered ileum could be enhanced by extramural support from wrapped rectus abdominis muscular flap. This technique could setup a reliable, easy catheterization continent cutaneous efferent tube.