Simple antireflux valve in ileal bladder substitutes: an experimental study in dogs

To provide a simple, reliable, and easy antireflux valve in ileal bladder substitutes.

Forty centimeters of the terminal ileum were isolated. A double-folded pouch was formed using the distal 37 cm, of which the proximal 7 cm were left intact to act as a valve. The remaining distal 30 cm were detubularized. Suturing at the borders of the valve was performed through linear seromuscular grooves created by diathermy burn. The ureters were anastomosed end-to-side to the supravalvular segment. The pouch was anastomosed to the trigone after subtotal cystectomy. The technique was carried out in 10 female mongrel dogs. All dogs were evaluated by ascending cystography and excretory urography at 12 and 20 weeks. Autopsy and histopathologic examination of the valve were carried out after the animals were killed at 20 weeks.

None of the 10 animals showed ureteral reflux in ascending cystography. Excretory urography revealed a perfect upper tract except in a dog that showed bilateral hydroureteronephrosis due to bilateral ureteroileal stenosis.

This new valve is technically simple and easy. The procedure is not time consuming, and staples are not required. The vascular pedicle is not manipulated. A shorter ileal segment is used in this type of valve construction in comparison with that required for the intussuscepted valve. This valve appears to be reliable for reflux prevention in ileal bladder substitutes.