Reinforcing the continent mechanism of continent cutaneous diversions by wrapped rectus abdominis muscle flap: a preliminary experimental study.
BACKGROUND
Continent cutaneous diversion (CCD) has been widely used in almost any lower urinary reconstruction. We have been continually trying to modify this procedure because of the high complications rate, especially as they relate to the efferent tube. In this study, we reported a modified procedure with a tapered ileum wrapped by the rectus abdominalis flap (RAMF) and assessed the feasibility of this new technique to achieve urinary continence.


METHODS
A procedure in which two ileal segments were tapered and connected to a U-shaped reservoir was performed in ten dogs. A RAMF with its blood supply was wrapped around one of the tapered ileum. In control groups, the tapered ileum was brought to the abdominal skin. Urodynamic studies were conducted In the 1st, 3rd and 6th months post-operatively. The data of maximum inner pressure (MIP) and functional pressure length (FPL) in every group at each phase were recorded. Retrograde radiograms of the efferent limbs were performed before sacrifice.


RESULTS
MIP in the study group was significantly higher than that in the control group at each phase (P < 0.05). However, no significant differences in MIP or FPL were found in the study group between an empty and full reservoir. In the control group, MIP increased (P < 0.05) and FPL decreased significantly (P < 0.05) compared with an empty and full reservoir. Retrograde radiograms confirmed that efferent limbs were positioned straigh beneath the abdominal wall. Histological examination of the study group demonstrated a layer of striated muscle around the outside surface of the ileum.


CONCLUSIONS
The continent mechanism of tapered ileum can be enhanced by extra support from wrapped RAMF.
Zhang
Xin-ru
XR
Department of Urology, Shanghai Jiaotong University Affiliated Shanghai 6th Hospital, Shanghai, China.
Xu
Yue-min
YM
Feng
Chao
C
Yu
Jian-jun
JJ
Song
Lu-jie
LJ
Fei
Xiao-fang
XF
D000818:Animals; D004285:Dogs; D005260:Female; D007082:Ileum / Q000601:surgery*; D008297:Male; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent; D014563:Urodynamics