title: An alternative continence tube for continent urinary reservoirs: evaluation of surgical technique, pressure and continence study in an ex-vivo model.
abstract: OBJECTIVE
  Despite the large number of surgical techniques for continent cutaneous diversion described in literature, the creation of a reliable, continent and easily catheterizable continence mechanism remains a complex surgical procedure.
  
  
  OBJECTIVE
  Aim of this study was the evaluation of a new method for a catheterizable continence mechanism using stapled pig intestine.
  
  
  METHODS
  Small and large pig intestines were used for construction. A 3 or 6 cm double row stapling system was used. Three variations using small and large intestine segments were constructed. A 3 or 6 cm long stapler line was placed alongside a 12 Fr catheter positioned at the antimesenterial side creating a partially two-luminal segment. Construction time for the tube was measured. The created tube was then embedded into the pouch. Pressure evaluation of the continence mechanism was performed for each variation. Intermittent external manual compression was used to simulate sudden pressure exposure.
  
  
  RESULTS
  All variations were 100% continent under filling volumes of up to 700 ml and pressure levels of 58 +/- 6 cm H(2)O for large intestine and 266 ml and 87 +/- 18 cm H(2)O for small intestine, respectively. With further filling above the mentioned capacity suture insufficiency occurred but no tube insufficiency. Construction time for all variations was less than 12 min.
  
  
  CONCLUSIONS
  The described technique is an easy and fast method to construct a continence mechanism using small or large intestine. Our ex vivo experiments have shown sufficient continence situation in an ex-vivo model. Further investigations in an in-vivo model are needed to confirm these results.
authors.affiliation: Department of Urology, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany, patrick.honeck@uro.ma.uni-heidelberg.de
authors.forename: Patrick
authors.initials: P
authors.lastname: Honeck
authors.forename: Maurice Stephan
authors.initials: MS
authors.lastname: Michel
authors.forename: Lutz
authors.initials: L
authors.lastname: Trojan
authors.forename: Peter
authors.initials: P
authors.lastname: Alken
mesh_terms: D000818:Animals; D007422:Intestines / Q000601:surgery*; D011312:Pressure; D013536:Suture Techniques; D013552:Swine; D016476:Urinary Reservoirs, Continent; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods