A COMPARISON OF THE W-STAPLED ILEAL RESERVOIR WITH HAND-SEWN RESERVOIRS FOR ORTHOTOPIC BLADDER REPLACEMENT

Objectives. Confidence has increased in the use of an orthotopic reser voir to the urethra after a cystoprostatectomy for bladder cancer; how ever, many surgeons would welcome a method to simplify the operative p rocedure. The availability of absorbable staples on a GIA stapler allo ws study of the incorporation of stapling procedures into formation of a reservoir. Because of the success of hand-sewn W-configured ileal r eservoirs, we initiated a Phase II study to evaluate absorbable staple s in formation of a W-configured reservoir. We now present an expanded contemporary series comparing a W-stapled ileal neobladder with hand- sewn ileal (Studer) or hand-sewn ileocolic (Le Bag) reservoirs. Method s. Forty-five selected patients underwent orthotopic urinary diversion after cystoprostatectomy for bladder cancer (n = 42) or prostate canc er (n = 3) using one of the three methods of reservoir construction. T here were 43 men and 2 women. The evaluation included a urodynamic eva luation and a questionnaire sent to patients inquiring about urinary f unction. Results. Most patients did well with the W-stapled ileal rese rvoir but 6 of 19 evaluable patients had unsatisfactory reservoir char acteristics. Three patients needed an augmentation cystoplasty and 3 h ad higher pressure, smaller volume reservoirs. Reservoir function appe ared to be consistently more favorable in patients with either of the hand-sewn reservoirs using an ileal or ileocolic segment. Conclusions. Although the W-stapled ileal reservoir is safe and allows reservoir f ormation quickly, the inconsistencies of the results discourage its us e in the particular configuration described. Failure of the reservoir to distend could be a function of reservoir design, areas of ischemia in the reservoir, or reaction to staple material. Absorbable staples o n the GIA instrument may work satisfactorily for formation of an ileoc olic reservoir for continent cutaneous diversion. However, the W-confi gured orthotopic reservoir as constructed using absorbable staples in this study is inferior to a hand-sewn ileal or ileocolic neobladder.