Suture-free technique of extravesical ureteroneocystostomy with ring pin stapler: experimental study of canines. I. Preliminary results.
OBJECTIVE
To compare the mechanical and sutured ureteroneocystostomy in a canine model.


METHODS
In 18 dogs, extravesical ureteroneocystostomy on 1 side was randomly assigned to end-to-side anastomosis performed with a titanium ring-pin stapler or interrupted absorbable sutures. To create the antireflux tunnel, the longitudinal line of the muscle layer was closed over the implanted ureter with titanium clips or sutures. At 3 months postoperatively, renal ultrasonography, intravenous urography, ascending cystography, the Whitaker test, and the macroscopic and microscopic results were assessed.


RESULTS
The ureteroneocystostomy with the ring pin stapler and the antireflux tunnel construction with titanium clips had a 100% technical success rate. Compared with manual suturing anastomosis, the suture-free technique took a significantly shorter time and resulted in slightly, but not significantly, less ureteral obstruction after 3 months. One dog in group 2 had evidence of ureteral dilation and hydronephrosis compared with the normal contralateral side. No signs of stone formation, urinary cyst, or fistulas were found after either closure method. None of the 18 dogs demonstrated vesicoureteral reflux. Histologic examination showed no signs of acute inflammation or marked fibrosis in any of the 18 specimens. Moreover, the intrapelvic pressure in group 1 was approximately similar to that of the normal contralateral side.


CONCLUSIONS
Ureteroneocystostomy performed with a titanium ring-pin stapler is feasible and faster than using conventional sutures. This suture-free technique is simple and safe, with possibly lower complication rates than a nonstented suture technique. Additional studies with a longer follow-up duration are needed to confirm these results.
Zhou
Feng
F
Department of Urology, Center of Nephrology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Fang
Zhen-Qiang
ZQ
Zhang
Yuan-Ning
YN
Chen
Wei
W
Liu
Yong-Liang
YL
Ye
Gang
G
D000818:Animals; D003559:Cystostomy / Q000379:methods*; D004285:Dogs; D004867:Equipment Design; D008297:Male; D013528:Surgical Staplers; D013537:Sutures; D014513:Ureter / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods