[Leakproof external urinary derivation. Apropos of a new technic]

Confronted by the need to find a system for cutaneous urinary derivation free of leakage, the authors used an invaginated isolated ileal loop which serves as a form of system of continence. When the bladder is intact the bladder neck is closed and the intestinal cuff attached directly to the bladder. This results in a leakproof trans-intestinal cystostomy. Good results have been obtained in 4 patients operated upon using this technique but follow up remains limited (maximum: 10 months). Elimination of the bladder as reservoir requires a different system which then becomes a leakproof trans-intestinal cutaneous ureterostomy. The system for avoiding leakage is extremely simple since using a Bricker type intestinal graft, the proximal end is closed and the distal end is merely invaginated inside the intestine for a distance of 8 cm. Six patients have been operated upon in this way, with a perfect functional result in 4 and 2 incomplete results. Because of necrosis of the invaginated segment of ileum, seen twice, in the future the authors intend to use a trans-sigmoid ureterostomy with a short invagination not exceeding 3 or 4 cm. This technique for continent external urinary derivation is of great social benefit. However it implies a need for discipline on the part of the patient and the small number of cases treated thus far is such that there must be great caution in terms of the assessment of long term results, in particular in children with malformations and vesicorenal reflux which might be worsened by the elevated pressure within the system.