A new technique for continent urinary diversion.

Canine experimental surgery was used to investigate the feasibility of creating a new continent urinary reservoir. Remodelled ileum was used to fashion this reservoir like the Kock pouch, but without either of the intussuscepted nipple valves which it uses. Ureters were implanted directly into the wall of the reservoir using a nonrefluxing technique. Continence was obtained by plication of a short limb of intact ileum exiting from the reservoir through which intermittent catheterization was performed. Three of four animals which remained infection-free had good to excellent results. Reservoir infection in four additional animals was associated with failure due to ureteral obstruction. The advantages of this reservoir include the use of ileum to achieve a low-pressure reservoir, the absence of the complex nipple valves of the Kock pouch, and the absence of foreign bodies such as staples and artificial sphincters. While the followup in this study is recognized as relatively short-term, the successes seen in this difficult-to-use animal model suggest that further evaluation of this simplified procedure is warranted.