Urodynamic aspects of continent urinary diversion. Review

Continence following urinary diversion depends on factors related to the reservoir and outlet. The reservoir should possess good compliance and no or atmost low pressured phasic contractions. The outlet should provide adequate outflow resistance to allow expulsion of urine under voluntary control and at convenient intervals. Overcoming high intra-reservoir pressures by producing high outlet resistance may endanger the upper urinary tracts. There is evidence that a low pressure reservoir may be constructed from any part of the bowel as long as detubularization of the segment is performed. All types of intussuscepted valves possess an inherent tendency to dessuscept despite various techniques which are employed to stabilize them. The causes are discussed and a recently described technique to overcome this problem is reviewed.