Simple flap valve for continent urinary diversion.

OBJECTIVE: To provide a stable continence mechanism in patients with urinary diversion by creating a flap valve from the ileal wedge, sutured into the grooves of the reservoir mucosa. PATIENTS AND METHODS: The valve's efficacy and stability were confirmed previously in an experimental study using five dogs. The valve was used in 22 patients with ileocaecal pouches and as a continence mechanism for cystostomy in two paraplegic women. RESULTS: Continence was achieved in all but two patients. In these exceptions the valve was found to be abnormally short (only 2 cm). Re-operation restored one patient to continence but the second patient refused further surgery. There were no problems with either catheterization of the valve or with epithelialization of the serosal surface of the valve. CONCLUSION: The valve is easy to construct and requires only a small intestinal segment; it has long-term mechanical and functional stability and can be easily catheterized. The valve provides continence even with increasing reservoir content and will accept a large catheter, which seems to be important in preventing lithiasis.

An alternative in surgical treatment of post-irradiation vesicovaginal and rectovaginal fistulas: the seromuscular intestinal graft (patch).

The excellent results experienced with the use of seromuscular intestinal grafts in certain types of urological plastic operations encouraged us to use it (as a patch) also in the surgical management of vesicovaginal and rectovaginal fistulas. With this method, we treated 4 patients with post-irradiation fistulas who had previously undergone 1 or 2 operations. The seromuscular intestinal graft served as a direct partial wall replacement of the bladder or rectum. At the same time, it also supported the nutrition of the compromised tissues surrounding the fistula. There were no complications with epithelialization of the denuded muscular surface of the seromuscular intestinal graft (patch) facing into the bladder.