Our experience in orthotopic bladder substitution

Abstract

Research in the field of orthotopic neobladders springs from the need to improve their morphofunctional aspects and to simplify surgical procedures. The authors report their experience on a new method of orthotopic neobladder in 20 patients subjected to radical cystectomy for advanced bladder neoplasia between March 1991 and February 1996. The surgical technique consisted of preparing a reservoir with a simil Carney 2 type procedure modified by the authors using 45 cm of ileus, 30 cm of which are detubularised and reshaped into a spherical/ovoidal form with Poligya 75 staplers. The remaining segment was left intact for the ureteroileal anastomosis performed with the Wallace 1 procedure. This technique offers the following advantages: staplers enable rapid preparation of the neobladder, thus reducing operating time; the technique is easy to learn for urologists familiar with ureteroileostomy according to Wallace; an isoperistaltic segment of ileus for ureteral anastomosis reduces ureteral mobilisation and possibilities of reflux; reconversion into ileal conduit is easy in the event of reservoir failure or neoplastic urethral recurrence. The criteria for patient selection are given and the diagnostic follow-up algorithm done with biochemical, echographic, radiological and pressure studies. Particular attention was paid to the quality of life in relation to diurnal/nocturnal continence and micturitional interval. The authors conclude that this technique is surgically simple and rapid giving satisfactory clinical and urodynamic results.