Stable formation of the nipple valve in Kock pouch for diversion of the urinary tract.

Construction of a continent ileal urinary reservoir is associated with a high incidence of late complications because of malfunction of the nipple valve. Three important modifications in the operative procedures for the construction of the nipple valve were developed with significant improvements in late complication rates and end results. First is the use of Dacron (polyester fiber) fabric as a collar instead of Marlex mesh (polypropylene), which frequently causes erosion. The second is treatment of the mesentery using a CUSA (Cavitron Ultrasonic Surgical Aspirator) (Cavitron Co. Ltd.) instead of making Deaver's windows, thus preserving the blood supply to the nipple valves. Third is anchoring of the nipple valves to the anterior wall of the reservoir, preventing prolapse, the most frequent malfunction of the nipple valve. The incidence of malfunction of the nipple valve and the end results of this innovative urinary diversion using an internal reservoir were analyzed in relation to these modifications of the operative technique among 71 patients. To date, with an established mode of operation, the success rate is more than 95 per cent.