title: The Hadera continent reservoir: a new appendico-umbilical continent stoma mechanism for urinary diversion.
abstract: OBJECTIVE
  Creating a reliable continence mechanism for a continent reservoir is a great challenge. We describe an easily formed mechanism for allowing complete continence in such patients.
  
  
  METHODS
  The native appendix attached to a detubularized right colonic reservoir was used as the catheterizable efferent limb. The continence mechanism was created by crossing 2 nondetached right rectus muscle strips around the appendix.
  
  
  RESULTS
  At a mean followup of 32 months (range 4 to 52) in 17 patients complete continence was obtained between 2 to 4-hour self-catheterizations in all positions and even during straining.
  
  
  CONCLUSIONS
  This continence mechanism is easy to construct and creates a reliable continent stoma in all patients who are not candidates for orthotopic bladder replacement and who retain the native appendix. In patients who have undergone appendectomy an alternate method is to create a small caliber efferent limb from a tailored terminal ileum and build the continence mechanism around it.
authors.affiliation: Department of Urology, Hillel Yaffe Medical Center, Hadera and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Yachia
authors.forename: N
authors.initials: N
authors.lastname: Erlich
mesh_terms: D000368:Aged; D001065:Appendix / Q000601:surgery; D003106:Colon / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014472:Umbilicus / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent