Salvage procedures for failed Benchekroun hydraulic valves: experience in four patients

To describe the complications encountered with the Benchekroun hydraulic valve and the salvage procedures used to convert it into a successful continent diversion.

Seven patients with spina-bifida (two males and five females) presenting with neurogenic incontinence were treated originally with a combined urethral lengthening (Pippi-Salle procedure), detubularized ileocystoplasty and Benchekroun hydraulic valve. Four of these patients presented with immediate (three) or subsequent (one) complications related to the devagination or the overdistension of the hydraulic valve, and stomal problems. Two techniques were used to create a catheterizable conduit with the intestinal material of the Benchekroun hydraulic valve; one used the inner tube of the valve and the other one used the appendix. These techniques are described and illustrated.

All four patients made a satisfactory recovery and had no difficulty in catheterizing their bladder through the revised continent diversion. However, the follow-up of these patients was short (1-8 months) and a long-term assessment is required to evaluate these salvage procedures.

The Mitrofanoff procedure remains our first choice to create a continent diversion in children with neuropathic bladders. However, when the appendix is not available or unusable, alternative procedures such as the Benchekroun hydraulic valve might be used to create a continent catheterizable conduit. Nevertheless, complications or failure of the Benchekroun valve and its variants (e.g. Guzman's technique) are common and salvage procedures are often necessary to recreate an efficient continent conduit.