Indiana Continent Urinary Reservoir

Rowland, Randall G.; Mitchell, Michael E.; Bihrle, Richard; Kahnoski, Richard J.; Piser, Joel

doi:10.1016/s0022-5347(17)44428-4

Cited by 399 publications

(87 citation statements)

References 5 publications

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“…The absence of a naturally lubricating mucosal surface in the catheterizable lumen, as is the case in other forms of continent diversion [2,4,5,10,12,15], may explain the excessive rate of stomal stenosis (73%) that develops with the hydraulic ileal valve on long-term follow-up. The coexistence of stomal stenosis and devagination in some cases, moreover, raises the possibility that devagination may develop secondary to high reservoir pressures due to stomal stenosis.…”

Section: Discussionmentioning

confidence: 99%

Evolution of outcomes with the ileal hydraulic valve continent diversion: reevaluation of the Benchekroun catheterizable stoma

1996

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Initial reports with limited follow-up suggested that the ileal hydraulic valve was a satisfactory approach to continent urinary diversion that was associated with acceptable early complication rates and uniform efficacy in achieving continence. We sought to evaluate the later outcomes of patients with this form of continent urinary diversion. An average extended follow-up of 5 years was available on 11 patients who had undergone ileal hydraulic valve diversion. Although only 13% of patients had complications requiring surgical revision at 18 months of follow-up, at the 5-year follow-up, 91% had developed complications requiring surgical revision. Of these, 64% entailed major revision of the urinary diversion. The most common late complication was stomal stenosis (73%); calculus formation (36%) and devagination (36%) were also common. Although in some cases, stomal stenosis was successfully managed by superficial revision with skin flaps and grafts, most cases required complete replacement of the efferent limb. Use of the devaginated or stenosed ileal hydraulic valve to construct a flap-valve efferent limb based on the Mitrofanoff principal succeeded in salvaging the continent urinary diversions in these patients. Novel forms of urinary diversion require extended follow-up for accurate assessment of their feasibility and efficacy. Attentive surveillance with surgical revision as necessary in such cases is mandatory for the preservation of continence and renal function.

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Section: Discussionmentioning

confidence: 99%

Evolution of outcomes with the ileal hydraulic valve continent diversion: reevaluation of the Benchekroun catheterizable stoma

1996

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“…Our initial approach was a modification of the imbrication procedure utilized in construction of the continent ileocecal reservoir [18,19], the antimesenteric surface of the intestinal conduit is folded inward and the upper edges of the trough created by this fold are sutured together [20]. This narrows the luminal diameter and increases resistance to flow.…”

Section: Discussionmentioning

confidence: 99%

Continent small-intestine reservoir construction: a tapered intussusceptum promotes sustained continence

et al. 1996

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Developed for the study of dialysis in the continent jejunal reservoir (CJR), a novel, uncomplicated approach to achieve continence in construction of a small-bowel reservoir is presented. We utilize a technique of constructing a continent nipple valve, which entails the reduction or tapering of the intussusceptum prior to invagination into the reservoir. We have thus far performed the procedure successfully in 21 dogs. All animals have achieved absolute continence. Complications have occurred in two animals, neither complication involving the nipple valve. Pressure-volume cytometry in nine animals demonstrates continence in the awake animal at pressures of up to 40 cm H2O (volumes being limited by animal discomfort due to reservoir distention). In postmortem studies, reservoir capacities of > 1000 ml and pressures of > 70 cm H2O have been attained without loss of continence or prolapse of the nipple valve. Continence is sustained even when the reservoir and nipple valve are subjected to high intraluminal pressures. Incorporating a tapered intussusceptum, the continent reservoir provides absolute continence without the use of cumbersome mesh fixation or lithotropic intraluminal staples.

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“…The array of right colon pouches that can be facilitated by our technique include the Indiana pouch [14], the Florida pouch [7], the UCLA pouch (S. Raz, personal communication), and the Duke pouch [ 17]. Reservoirs using terminal ileum and cecum such as the Penn pouch [3] and the Mainz pouch [16] can also be fashioned in this manner.…”

Section: Right Colon Pouchmentioning

confidence: 99%

Absorbable stapling techniques in continent urinary diversion

1996

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The principle of bowel detubularization to decrease peristaltic pressure and increase reservoir capacity is applied in contemporary continent urinary diversions. The process of detubularization and refashioning of the spatulated bowel segment approximates 1 of operating time and is the most time-consuming aspect of pouch construction. The employment of devices applying absorbable staples ("absorbable staplers") has substantially reduced the time required to fashion bowel reservoirs. This article reviews the adaptation of the absorbable stapler to continent urinary diversion using small- and large-bowel segments.

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Indiana Continent Urinary Reservoir

Cited by 399 publications

References 5 publications

Evolution of outcomes with the ileal hydraulic valve continent diversion: reevaluation of the Benchekroun catheterizable stoma

Evolution of outcomes with the ileal hydraulic valve continent diversion: reevaluation of the Benchekroun catheterizable stoma

Continent small-intestine reservoir construction: a tapered intussusceptum promotes sustained continence

Absorbable stapling techniques in continent urinary diversion

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