Simplified reflux prevention in continent lower urinary tract reconstruction: The split cuff nipple technique

Anthony R. Stone, Jae H. Kim, Palricia Fone, U. C. Davis

Research output: Contribution to journalArticlepeer-review


Continent reconstruction, either orthotopic bladder replacement or continent diversion, are now standard practice following cystectomy. The need for reflux prevention from these urinary reservoirs is contravcrtial. Methods include an inlussuscepted bowel nipple, tubulari/cd afferent segment, the Le Duc Camay technique, or tunneled techniques, either serosal or submucosal. Drawbacks of these are that some are not universally applicable to all reconstructions, additional bowel may be required and some have a relatively high incidence of stenosis. This paper describes the use of the split cuff nipple ureteric implantation technique(SCN), as an alternative method of reflux prevention, that is applicable into all bowel segments , spares bowel and has a low complication rate. 50 patients (ileal orthotopic bladder 35, Indiana pouch 15) have undergone continent bladder reconstruction following cystectomy, using the SCN technique to prevent reflux. The split cuff ureteric nipples were constructed using the technique described by Stone et al (J. Urol . 142:707-709,1989).The nipples were implanted into the left hand comer of the ilcal reservoir or the dependent portion of the cecum. Follow up (3months-7years) consists of upper tract assessment (ultrasound, intravenous pyclogram, and cyslogram), urine cultures and scrum electrolytes . Early complications associated with the implantation technique consisted of 2 cases of obstructive uropalhy, related to stent migration, requiring temporary nephrostomy. Longer term follow up revealed 3additional cases of obstructive uropathy, necessitating antegradc manipulation in 2 and open correction in 1. No reflux has been seen on cystography at 12 months and no other upper tract problems have been encountered during follow-up. The integrity of nipples long term has also been confirmed cndoscopicalk. Split cuff nipple ureteric implantation is a reliable antireflux technique applicable to all forms of lower urinary tract reconstruction. It avoids the use of an extra bowel segment, the need for staples and complications are few.

Original languageEnglish (US)
Pages (from-to)86
Number of pages1
JournalBritish Journal of Urology
Issue numberSUPPL. 2
StatePublished - 1997

ASJC Scopus subject areas

  • Urology


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