[The postoperative effects of tapered terminal ileal continent urinary reservoir]

We report postoperative effects of 23 cases having tapered terminal ileal continent urinary reservoir is reported. The operative technique was characterized by tapering the terminal ileum with stapler to form a continent efferent tract, segments of intestine were cut open and reformed a pouch, and the ureter implantation was performed by means of inserting the end of ureters into the pouch. Ileocolonic pouch wes constructed for 14 patients and colonic pouch for 9 patients. 22 patients were followed up for 1 to 6 years except one died of cerebral hemorrhage 2 weeks after operation. Urine continence were achieved in all patients and self catheterization could be easily undertaken with 20F-22F catheter in 21. Difficulty in catheterization was happened in one early case. One year after operation, the maximum volume of the ileocolonic pouch was 900 ml-1000 ml. The basal and intermittent pressure of the filling pouch was 0.49 kPa-1.96 kPa respectively. The maximum volume of the colonic pouch was 400 ml-500 ml. The basal and intermittent pressure of the filling pouch of the colonic pouch was 0.98 kPa-1.9 6 kPa and 1.96 kPa-3.93 kPa respectively. The complication of pouch overdistention was found in 6 cases, pouch stone formation in 2 and pouch infection in 12 episodes. There was no evidence of ureteral obstruction or reflux and significant hyperchloric acidosis. It is recognized that tapered terminal ileum is a good way to construct a continent efferent tract, both ileocolonic pouch and colonic pouch can meet the need of low inner pouch pressure so long as the intestines were cut open and reformed, and efforts must be made to prevent the complications of pouch overdistension, stone formation and pouch infection.