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Introduction: A sufficient and easily catheterizable continence mechanism is essential in continent cutaneous pouches. Kälble embedded a tapered ileum as efferent segment into a serosal lined tunnel formed by an ileal ‘U’ according to the principle of Abol-Enein and Ghoneim. We report a modified technique applied in a series of 12 patients who had undergone different urinary diversions. Methods: All patients received a modified Kälble procedure (first-line urinary diversion, n = 8; revision/undiversion, n = 4) for different forms of continent pouches. To alleviate embedding of the efferent segment, ileal detubularization was performed asymmetrically. Mean follow-up was 9.5 months. Results: All patients were continent and performed self-catheterization easily. Of 12 patients, 2 underwent endoscopic incision for stomal stenosis 8 and 12 months postoperatively. Conclusions: Subject to our short follow-up, Kälble’s technique is a promising alternative in patients undergoing a continent cutaneous urinary diversion but offers an inapplicable or missing appendix.

Purpose: To establish an animal model for studying the effects of vaginal trauma and oophorectomy on the continence mechanism in rats. Methods: Ninety-six female rats were used in the experiments. The rats were divided into 8 groups that received either no treatment (control), or single vaginal trauma at 0 day and 4 weeks, multiple vaginal traumas, oophorectomy at 4 and 12 weeks, and combined oophorectomy and single vaginal trauma or multiple vaginal traumas at 4 weeks. In vivo experiments were performed to determine abdominal leak point pressure (ALPP) by recording the intravesical pressure obtained during compression of the lower abdomen. In vitro urethral contractility experiments were then performed using isolated urethra and electrical field stimulation, acetylcholine, and norepinephrine. Finally, histological study of the urethral muscles and paraurethral structures was performed. Results: Single or multiple vaginal traumas resulted in a significant reduction of ALPP. The reduced ALPP recovered at 4 weeks after single vaginal trauma. Oophorectomy did not significantly affect ALPP compared to controls; however, when oophorectomy was combined with multiple vaginal traumas, a significant reduction in ALPP occurred. Urethral contractility was reduced after multiple vaginal traumas but was not significantly different from the control after oophorectomy. Histological studies revealed disruption of the ventral part of striated muscles after single or multiple vaginal traumas. Degenerative and hyalinization changes were noted in submucosal and muscle layers after oophorectomy combined with multiple vaginal traumas. Conclusions: Vaginal trauma can injure the urethral muscles and nerves. Single or multiple vaginal traumas can induce denervation of periurethral muscles and reduce ALPP. With a period of recovery, the urethral resistance increases and ALPP returns. Oophorectomy mainly affected the intrinsic urethral closure mechanism and resulted in a nonsignificantly reduced ALPP; however, a significant reduction of ALPP developed when oophorectomy was combined with multiple vaginal traumas.

By creating continent supravesical diversions or continent vesicostomies, various methods of continence mechanism can be distinguished. They all are based on the principle that the pressure in the conduit is higher than in the reservoir. Twenty-eight patients with various urinary diversions and different continence mechanisms were followed up by clinical investigation, questioning and urodynamic evaluation. The latter showed similar results with regard to efferent loop pressure. The best results concerning easy catheterization and safe continence are reached by appendix stoma and tapered ileum.