Stabilization of the nipple base with titanium rings when reoperating patients with continent urostomies for nipple dysfunction.

Nipple dysfunction in Kock reservoirs used for continent urinary diversion is usually caused by a flattening out of the intestinal nipple due to a lateral tore at the base of the nipple when the reservoir expands. This study describes a new method to repair dysfunctioning nipples based on the use of titanium rings applied outside the reservoir around the base of the nipple. Experiments on dogs and rats have shown that rings and plates of titanium rapidly attach to the serosal surface of ileum exposed to urine with only minor signs of inflammation. Ten patients with Kock reservoirs for urinary diversion have been reoperated for nipple dysfunction due to nipple sliding with elongation of the nipple and fixation of the nipple base with titanium rings. The functional result is excellent in 9 out of the 10 patients. No signs of erosion of the rings into the reservoirs have been noted. With this new method for nipple repair the need for using more intestine to construct a new nipple is eliminated.