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At least 37 records · Page 2Linked to original sources
PubMed1977

Continent cecoileal conduit: preliminary report.

A continent cecoileal conduit to improve rehabilitation after external urinary diversion is described. The isolated cecum functions as a reservoir. The continence mechanism is constructed by intussuscepting the terminal ileum into the isolated cecum to form a nipple, preventing leakage of urine. The kidneys are protected from cecoureterorenal reflux by ureterocecostomies with submucous tunnels. We have used this technique on 4 patients, 2 of whom need no external urinary pouch since the urostoma is absolutely continent. One patient became incontinent 3 months postoperatively and is wearing a conventional bag and 1 patient died. There is no refluex into the kidneys. The upper urinary tract, which is dilated slightly 4 weeks postoperatively, tends to become normal after a few months.

Cecum↗
PubMed1975

[From anal atresia to continent organ].

In deep anal occlusion complete continence can nearly always be obtained by means of a perineal or sacroperineal operation. On the other hand, the results after reconstruction in case of high recto-anal agenesis are still doubtful. Placing the neorectum inside the junction of the levator ani muscles by the sacro-abdomino-perineal approach has improved the continence function. Manometric studies have shown that the organ of continence has to learn its function first, which may take months or even years. In cases of congenital motor or sensory defects, or iatrogenic lesions, at least partial normalization can be brought about by specific reconstructive operations.

Anus, Imperforate↗
PubMed1975

Continent ileal bladder: an experimental study in dogs.

A method for constructing a continent ileal bladder has been tested in dogs. The requirements for a continent ileal bladder: continence, reservoir function, prevention of reflux, could be fulfilled in our experimental study.

Animals↗
PubMed1978

A continent ileostomy and reservoir using the canine ileocolonic segment.

The present study was an attempt to create a simple reservoir with a reliable continent ileostomy, so as to overcome the many drawbacks of the regular ileostomy. The ileocolonic segment was isolated and the ileum was intussuscepted into the colon to augment the ileocolonic sphincter. Pressure recordings disclosed a high pressure zone in the ileocolonic sphincter area reacting with a significant pressure increase to colonic distention. The proximal ileal end was anastomosed to the colonic part of the ileocolonic segment, and the ileal part of the ileocolonic segment was maturated as an ileostomy. The colonic reservoir was emptied by catheterization. Between catherizations, the ileostomies remained completely continent to small intestinal contents and gas. The reservoir and continent ileostomy are easily constructed, offer convenience and safety, voluntary and controlled emptying and conservation of part of the water and sodium excessively lost with conventional ileostomies. The procedure should be applied only to those patients in whom the right colon is unaffected or only slightly affected by the inflammatory process.

Animals↗
PubMed1977

Dynamics of the continent ileal bladder. An experimental study in dogs.

A continent ileal bladder was constructed in six dogs. The most important requirements for a continent ileal bladder as a reliable mechanism of continency and for prevention of back flow in the ureters could be achieved by two intussusception valves (nipples) of small bowel in opposite directions. The dynamics of these "nipple valves" were studied electromanometrically and radiologically. These experiments showed that these intussusception valves did not binder a free flow in the isoperistaltic direction and did prevent reflux in the antiperistaltic direction.

Animals↗
PubMedDate not supplied

[Continent urinary diversion with the Florida pouch].

Continent urinary diversion (Florida Pouch) has been performed on 151 patients. The surgical technique utilizes a detubularized extended right colon segment, a doubly-plicated segment of ileum and a non-tunneled uretero-intestinal anastomosis. Mortality rate was 1.3%. Early and late complication rates have been minimal. 2.8% were incontinent. No radiographic renal damage has been noted and electrolyte abnormalities have not been a problem. The procedure is highly recommended to those surgeons performing continent urinary diversions.

Follow-Up Studies↗
PubMed1992

[Rehabilitation of patients after cystectomy and construction of a continent intestinal reservoir].

Close follow-up and rehabilitation are necessary in order to ensure a good life quality for patients who have undergone cystectomy operations combined with continent reservoir operations. A questionnaire survey was carried out on 19 of our patients with continent reservoirs of different types. Furthermore a number of the leading clinics and urologists were consulted in an effort to find out a common and reliable method for rehabilitation. The most frequently encountered problems were the sexual (13 cases: 72.2%) and psychosocial adaptation (11 cases: 61.1%) among our patients. These figures were lowered to 50% (9 cases) and 33.3% (6 cases) respectively after organizing a special club for these patients in our hospital.

Cystectomy↗
PubMed1979

Radiological assessment of nipple-valve insufficienty in Kock's continent reservoir ileostomy.

In a series of 51 continent reservoir ileostomies nipple-valve insufficiency developed in 15 patients who were examined radiographically to find the cause for the loss of continency. The radiological diagnosis was confirmed at reoperation. The causes for nipple-valve insufficiency were a total or partial disappearance of the nipple-valve by sliding of the invaginate (7 cases) and dislocation of an undamaged nipple out of the reservoir (8 cases). In these groups the radiological diagnosis was compatible with the operative findings in all but one case. At reoperation a fistula in the nipple-valve was found in 3 cases, but in no instance had this been diagnosed radiologically. A correct preoperative diagnosis is valuable, especially in cases of dislocation, where a danger exists that the real mechanism of valve insufficiency may remain obscure at operation.

Humans↗
PubMed1976

Psychiatric casualties following revision to the "continent" Kock ileostomy.

The advantages of the appliance-free "continent" Kock ileostomy over the conventional ileostomy may result in its earlier and more frequent use in treating ulcerative colitis. Caution must be observed in selecting patients for surgery because of the high incidence of psychological problems in this population. Increased restraint is especially indicated as such surgery may no longer be reserved for life-threatening or incapacitating conditions. As the Kock operation becomes more widely known, patients with conventional ileostomies are requesting revision to the reservoir. This paper addresses itself to unexpected problems that may arise in this group. Two cases are presented of men who made tenuous adjustments to the primary surgery but for whom revision to the continent ileostomy proved psychologically catastrophic. Psychiatric evaluation is urged in the absence of clear-cut medical indications for revision. Suggestions concerning selection of patients who seek such change are offered.

Adaptation, Psychological↗
PubMed1977

[Continence after low anterior resection (author's transl)].

In 28 patients we studied the fecal continence after low anterior resection of the rectum. After an usual proctological investigation we did in all patients measurements of the anorectal function, such as pressure measurement, electromyography and determination of the anal-rectal angle. In 12 patients a defecatogram was performed. Of the 28 patients with anastomoses lower than 8 cm only one was after 2 years still incontinent. All the other patients were completely continent. This fact could be proven objectively.

Adult↗
PubMed1976

The development of anorectal continence and its significance in the diagnosiso of Hirschsprung's disease.

The development of the anorectal continence reaction was studied in a series of 138 electromanometric recordings performed in 62 newborn and six premature infants. Forty-five babies were observed in a longitudinal study. In 11% an internal sphincter relaxation was observed at the time of birth. The same reflex was present in about 50% after the third day and in all infants after the 12th day of life. The development of a rectal continence reaction depends on an intact internal sphincter relaxation. The puborectalis muscle, is fully functional at birth. On the basis of these findings electromanometric recordings can be used to exclude aganglionic megacolon as early as the first day of life. An absent internal sphincter relaxation reflex, is diagnostic only after the 12th day of life.

Age Factors↗
PubMed1976

Manometric assessment of continence after surgery for imperforate anus.

Of 49 children with imperforate anus, 23 underwent an abdominoperineal procedure for a high and seven for a low maliformation, 17 had a perineoplasty for a low and two for a high malformation. In each subject, rectal and anal sphincteric resting pressures were studied at least 1 yr after surgery. Of 30 subjects who had undergone an abdominoperineal procedure, eight were continent in contrast to 15 out of 19 patients who had had a perineoplasty (p less than 0.001). In patients who had undergone an abdominoperineal procedure, the rectal motility was of the colonic type, with waves of higher amplitude and lower frequency (p less than 0.01) than in the normal rectum in 23 cases and in most of these, peristalsis was recorded down to the anal margin. Incontinence was most frequently associated with abnormally short anal resistance, low anal pressure, reduced sensibility, weak voluntary contraction and absence of rectoanal inhibitory reflex. In the group of patients who underwent perineoplasty, continence was associated with normal mechanical parameters and normal physiologic behavior of the anal sphincter.

Adolescent↗
PubMed1992

Hypogastric nerve section reveals a role for both afferent and efferent fibres in the feline continence process.

The role of the hypogastric afferent and efferent innervation in the process of urine storage during natural rate filling was examined in the pentobarbitone anaesthetized cat. The observed changes in bladder pressure following hypogastric nerve section demonstrated the presence of baseline sympatho-inhibitory and phasic sympatho-excitatory influences for a significant portion of each distension, which proceeded to a volume just over halfway through the continence process. A reduction in bladder wall compliance at the end of the distensions provided evidence for a net sympatho-inhibitory influence in the second half of the continence phase. Hypogastric nerve section also resulted in a reduction in the reflex increase in hypogastric efferent nerve activity, measured in-continuity. This suggested that hypogastric afferent fibres made a significant contribution to the regulation of sympathetic hypogastric nerve activity during natural rate filling.

Animals↗
PubMed1978

Closure of the bladder neck in patients undergoing continent vesicostomy for urinary incontinence.

The continent vesicostomy has been done on 24 patients, 10 of whom had severe urinary incontinence requiring closure of the bladder neck or urethra as well. Therefore, the bladder was converted to a closed cavity and intermittent catheterization is done through an abdominal stoma. No dressings or appliances are necessary. Bladder neck (or urethral) closure was successful in 8 of the 10 patients. One of the failures had been incontinent and was rendered continent on attempted bladder neck closure and there is urethral leakage at night in the other patient. Intermittent catheterization through a vesicostomy stoma has been cleaner and more aesthetically pleasing to the patients. The bladder neck closure has resulted in a dry perineum with fewer skin problems.

Adolescent↗
PubMed1978

Comparison of techniques to determine continence zone.

The urethral pressure profiles for 36 patients were analyzed specifically for continence zone by 3 techniques: 1) triangle, 2) planimeter and 3) weight. Graphically, the best agreement was between the weight and planimetry methods but, statistically, there was a significant difference among techniques except for the subgroup that had the smallest continence area.

Bladder Exstrophy↗
PubMed1977

The continent vesicostomy: clinical experiences in the adult.

During a 2-year period continent vesicostomy has been attempted in 17 adults and a continent stoma has been achieved in all but 4 patients. Operative morbidity is low and there has been no operative mortality. Definition of precise indications and contraindications must await further experience but this operative procedure seems to be a useful alternative in the management of neurogenic bladder and incontinence.

Adult↗
PubMed1976

The Kock continent ileostomy: a preliminary report.

A review is presented of seven patients who have undergone a continent type of ileostomy, as described by Professor Kock. There has been no mortality. Two of the early patients had considerable difficulty with the functioning of the valve and required re-operation. No patient in the series now wears an external appliance. Six of the seven are fully continent; the seventh reports occasional leakage, but is satisfied with the operation. The operation is considered to be still under trial, but is regarded as having great potential and likely to be much more widely practised in the future.

Adult↗