The ureter as a pedicle for construction of a ureteral urethra: the double tunnel

SEROSAL LINED EXTRAMURAL TUNNEL (GHONEIM) PRINCIPLE IN THE CREATION OF A CATHETERIZABLE CHANNEL IN BLADDER AUGMENTATION

PURPOSE

The flap valve mechanism is often the preferred technique for creating a continent catheterizable channel in bladder reconstruction. The umbilicus is usually the preferred site for stomal placement. However, it is not always possible to bring the conduit to the umbilicus when creating the flap valve mechanism at the bladder level. To prevent this problem, we applied the Ghoneim technique to construct the flap valve mechanism during ileal bladder augmentation.

MATERIALS AND METHODS

A total of 10 patients (7 boys and 3 girls) 5 to 17 years old underwent ileocystoplasty in combination with an appendiceal Mitrofanoff procedure as a catheterizable channel. The U-shaped ileal segment was anastomosed to the bivalve native bladder, leaving redundant bowel on the right side. The musculomucosal edges of the redundant bowel were sutured together, forming the posterior wall of the tunnel. The appendix was positioned onto the musculomucosal suture line, and the proximal end was anastomosed to the reservoir with an advancement suture. The ileal segment was then imbricated over the appendix by interrupted silk sutures, forming a serosal lined extramural tunnel. The stoma was placed at the depth of the umbilicus.

RESULTS

The underlying diagnoses included mylomeningocele (8) and posterior urethral valve (2). Mean followup time was 12.5 months (range 7 to 21). All patients were continent, and there were no stoma related complications such as stenosis or difficult catheterization.

CONCLUSIONS

The Ghoneim technique creates an effective continence mechanism and allows the conduit to reach the umbilicus easily.