title: Efferent tube suspension as a continent diversion mechanism: a preliminary report of a clinical study.
abstract: OBJECTIVE
  We constructed a reliable continent tube that is surgically simple.
  
  
  METHODS
  In 12 patients with malignant bladder tumor we performed radical cystectomy with isolation of a 50 cm. ileal loop with pedicle. The proximal segment (8 to 10 cm.) was tapered over a 16Fr catheter as an efferent tube, the remaining segment was detubularized to create a W-shape pouch and the tapered ileum was fixed to the back surface of the rectus muscle with 2 polyester tapers 1 cm. wide with a suspension tension of 500 g. The external orifice of the tapered ileum was anastomosed to the umbilicus. In 2 patients with neuropathic bladder a 15 cm. ileal loop with pedicle was isolated, the proximal segment (8 cm.) was tapered as an efferent tube with 500 g. suspension tension, and the remaining segment was detubularized and anastomosed to the bladder.
  
  
  RESULTS
  The patients were followed for 6 to 17 months (mean 11.4) and were completely continent day and night. The stoma was easily catheterized with a 16Fr catheter in all cases. Urodynamic study of the efferent tubes revealed maximum pressure of 84 to 159 cm. water (mean 114). Retrograde radiography of the efferent tubes demonstrated perfect canalization without stenosis.
  
  
  CONCLUSIONS
  This study suggests that the continent mechanism of the tapered ileum can be greatly enhanced by a suspension technique. This maneuver also provides easy catheterization and surgical simplicity.
authors.affiliation: Department of Urology, Sixth People's Hospital, Jiaotong University of Shanghai, China.
authors.forename: Yue-Min
authors.initials: YM
authors.lastname: Xu
authors.forename: Yong
authors.initials: Y
authors.lastname: Qiao
authors.forename: Den-Long
authors.initials: DL
authors.lastname: Wu
authors.forename: Ying-Long
authors.initials: YL
authors.lastname: Sa
authors.forename: Zhon
authors.initials: Z
authors.lastname: Chen
authors.forename: Rong
authors.initials: R
authors.lastname: Chen
authors.forename: Xin-Ru
authors.initials: XR
authors.lastname: Zhang
authors.forename: Jiong
authors.initials: J
authors.lastname: Zhang
authors.forename: Zhon-Rui
authors.initials: ZR
authors.lastname: Jin
authors.forename: San-Bao
authors.initials: SB
authors.lastname: Jin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D002648:Child; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007082:Ileum / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D017568:Rectus Abdominis / Q000601:surgery; D018233:Rhabdomyosarcoma, Embryonal / Q000601:surgery*; D013536:Suture Techniques; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D014546:Urinary Catheterization; D016476:Urinary Reservoirs, Continent; D014563:Urodynamics / Q000502:physiology; D014567:Urography