title: Effectiveness of a handsewn nipple valve for reflux prevention in bladder reconstruction.
abstract: The intussuscepted nipple has proved to be a versatile mechanism to provide continence or prevent reflux in urological reconstructive surgery. Early in its use detussusception of the nipple was recognized as a common complication, which was usually prevented by using several rows of staples to stabilize the nipple. The use of staples has reduced the rate of reoperation for eversion or obstruction but it has led to a higher stone formation rate, ranging from 10 to 18% in recent series. Since 1983 we have used a handsewn intussuscepted ileal nipple stabilized without staples as our antireflux mechanism in bladder augmentations and continent diversions. This technique has been performed in 30 patients with an average followup of greater than 3 years. A small bladder stone developed in only 1 (3%) of the patients, who was completely dependent on intermittent catheterization, while 4 (13%) required reoperation due to eversion of the nipple. This incidence compares well with nipple reoperation rates in recent series, which range from 7 to 28%. We conclude that absorbable sutures are as effective as staples in stabilizing the antireflux nipple, and that they result in a lower incidence of subsequent stone formation.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
authors.forename: R M
authors.initials: RM
authors.lastname: Friedman
authors.forename: S C
authors.initials: SC
authors.lastname: Flashner
authors.forename: L R
authors.initials: LR
authors.lastname: King
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008722:Methods; D011183:Postoperative Complications / Q000517:prevention & control*; D012086:Reoperation; D014513:Ureter / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery*; D001744:Urinary Bladder Calculi / Q000209:etiology; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects; D014718:Vesico-Ureteral Reflux / Q000209:etiology / Q000517:prevention & control*