Non-refluxing ileal ureter replacement using intussuscepted nipple valve--an experimental study in dogs

Abstract

ニップルバルブを作成するのに新しい方法を用いた.全てのイヌは, 6ヵ月間経過観察をし, BUN, クレアチニン(Cr), 血清電解質, 尿培養, IVP, 膀胱造影, 尿流動態検査を施行した.全てのイヌで, 術前と術後6ヵ月のBUN, Cr, 電解質の値に変化はなかった.ニップルバルブの重積が滑脱した1例のみが逆流を示した.IVPやWhitaker試験では尿路閉塞は認められなかった.更に, ニップルバルブにより膀胱内圧の上昇は上部尿路に伝達されなかった.尿路に用いても, 重積させたニップルバルブは我々の手技で固定させることが可能であり, 逆流を防止する事が可能であると思われた

Although the vast accumulation of data from the continent urinary reservoir clearly proves that intussusception of the ileum is a reliable procedure for preventing urine reflux, few reports have appeared on the application of this technique to ileal replacement of the ureter. In an effort to determine if the nipple valve created by the intussuscepted ileum can prevent urine reflux in the ileal ureter, an experimental study was done using five dogs. I performed ureteral replacement using a newly developed procedure to secure the nipple valve in place. All dogs were followed for 6 months and evaluated by blood urea nitrogen (BUN), creatinine (Cr), serum electrolyte, urine culture, intravenous urogram (IVU), cystogram, and urodynamic studies. No significant differences were notable between the preoperative and 6-month postoperative values of BUN, Cr, and serum electrolytes in all dogs. Only one of the dogs, which showed extussusception of the nipple valve, demonstrated the reflux. IVUs and Whitaker flow studies did not confirm any urinary outflow obstruction. Furthermore, during the pressure studies, the nipple valve prevented transmission of the increased intravesical pressure to the upper urinary tract. I believe that the intussuscepted ileum can be secured by our procedure and can prevent reflux even though it is incorporated into the urinary system itself.