Orthotopic neo-bladder techniques

Abstract

“Replacement” intestinal neo-bladders have been created or refined in many cases following cystectomy for various pathologies (iatrogenic, phlogistic, neurologic or neoplastic), in order to permit natural micturition and to keep the patient's body image intact. The requisites of the neo-reservoir are: adequate capacity, reduced internal pressure, an anti-reflux ureteral and continent urethral anastomosis. Based on the principles of hydraulic physics, literature considers that the double folding configuration (with front and sagittal folding guaranteeing the desynchronisation of peristalsis, maximum increase in capacity and reduction in reservoir pressure) is a confirmation of the excellency of the “spherical reconfiguration” of the detubularised segment. Thanks to the use of anti-reflux methods, the attention paid to the urethral anastomosis and the possibility in selected cases of nerve sparing surgery, today the orthotopic neo-bladder is the best and least costly diversion operation (no expendable materials used, reduced management time). The orthotopic diversion techniques most widely known and used in Italy are described. These involve the use of ileal, ileo-cecal, ceco-colic or sigmoid segments. Results are analysed from a clinical and urodynamic aspect. Points which are stili not clear concern the behaviour in time of the reservoir capacity, the repercussions on the upper urinary tracts and on the metabolism, as well as the long-term effects on the intestinal mucosa. Long follow-ups and comparative studies on homogeneous and numerically consistent case histories are therefore considered appropriate.