title: The failed anti-incontinence mechanism: a flap valve or cecal wrap for surgical reconstruction.
abstract: OBJECTIVE
  On a long-term basis patients with continent urinary diversions may have an acceptable number of complications, such as urinary incontinence. We report on a new surgical technique for treatment of the incompetent anti-incontinence segment.
  
  
  METHODS
  Seven patients presented with a large capacity, low pressure reservoir and an incompetent anti-incontinence mechanism. The original anti-incontinence mechanism consisted of an intussuscepted reimplanted appendix (Mitrofanoff) in 2 patients, tapered ileum and reinforced ileocecal valve in 3, and tapered and reimplanted ileal segment in 2. Surgical reconstruction involved 2 stages: stage 1 - lengthening and tubularizing the cecum with the anti-incontinence segment and stage 2 - creation of the flap valve mechanism. Stage 2 required intraoperative modification when abundant peri-reservoir fibrosis, a thin-walled reservoir (cecal wrap) or an excessive thickened mesentery was encountered.
  
  
  RESULTS
  After a mean followup of 7 months 6 of 7 patients performed catheterization every 4 hours and were continent. Several patients required a concomitant procedure with the incontinence revision.
  
  
  CONCLUSIONS
  We describe a 2-stage technique for correction of a variety of untoward anatomical conditions related to a failed anti-incontinence segment with continent urinary reservoirs. Concomitant repair of other coexisting structural abnormalities related to the continent reservoir may also be necessary.
authors.affiliation: Department of Surgery, University of South Florida Health Sciences Center and H. Lee Moffitt Cancer and Research Institute, Tampa, USA.
authors.forename: P
authors.initials: P
authors.lastname: Austin
authors.forename: E
authors.initials: E
authors.lastname: Spyropoulos
authors.forename: H
authors.initials: H
authors.lastname: Arango
authors.forename: J
authors.initials: J
authors.lastname: Fiorica
authors.forename: Y
authors.initials: Y
authors.lastname: Homsy
authors.forename: J
authors.initials: J
authors.lastname: Lockhart
mesh_terms: D000328:Adult; D000368:Aged; D002432:Cecum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control*; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects*