Hydraulic valve for continence and antireflux. A 17-year experience of 210 cases

The hydraulic ileal valve ensures urinary continence and can be employed in many different reservoirs. The valve is constructed by isolating a 14 cm long intestinal loop with its mesentery. The isolated ileal segment is then folded inward on itself throughout its length. This hydraulic valve was used in the construction of 210 continent urostomies--ileocaecal reservoir in 184 cases (including 8 detubularized), ileal reservoir in 15, sigmoid in three, rectum and transverse colon one each, and bladder (continent cystostomy) in six cases. The indications for continent urostomy included bladder tumour (45.5% of cases), complex vesicovaginal fistula (31%), neurogenic bladder (11%) and bladder exstrophy (7%). Continence was immediately achieved in 155 patients (75%), rising to 91.5% after valve repair. The mean postoperative follow-up was 56 (range 3-205) months.