A Long-Tunnel Modification of the Combined Principle after Leadbetter and Clarke as True Antireflux Uretero-Ileal Anastomosis

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Abstract
The purpose of this study, involving 25 female mongrel dogs, was to develop a technique of uretero-ileal anastomosis that would avoid the danger of ureteric obstruction and urinary extravasation and prevent reflux, even when exposed to extreme pressures. The combined principle, developed by Leadbetter and Clarke, offers 3 theoretically possible modifications that were successively applied to the ileal conduit. The technically simplest one, as described by Kelalis, and the long-tunnel modification of the Leadbetter-Clarke technique resulted in ureteric obstruction and high-pressure reflux, respectively, in a high percentage. The last modification of the combined principle, not described before, allows the ureter to develop free peristalsis, covered only by ileal mucosa and unimpeded by any muscular tension. Renal units (12) implanted according to this last technique were fully protected from reflux when subjected to a pressure of 25 cm of water. High pressure reflux was observed in only 2 renal units. When these 12 renal units were compared with 12 renal units implanted into the same ileal conduit according to Cordonnier, a statistically significant difference as to the pyelonephritic involvement of the corresponding kidneys could be established with preponderance to the inflammatory changes on the refluxing side (P < 0.05).