THE ILEOCAECO-URETHROSTOMY WITH MULTIPLE TRANSVERSE TAENIAMYOTOMIES FOR BLADDER REPLACEMENT - AN ALTERNATIVE TO DETUBULARIZED NEOBLADDERS -MORPHOLOGICAL, FUNCTIONAL AND METABOLIC RESULTS AFTER 9 YEARS EXPERIENCE

Objective To evaluate the results from the long-term follow-up of ileo caeco-urethrostomy with multiple transverse taeniamyotomies for bladde r replacement. Patients and methods Since 1987, 60 male patients have undergone bladder replacement using a technique of ileocaeco-urethrost omy with multiple transverse taeniamyotomies, Avoiding detubularizatio n, sectioning the caecal taeniae improved reservoir morphology and red uced internal pressures and wall tension, limiting the potential compl ications of the operation, Results All patients achieved diurnal conti nence with socially acceptable intervals between micturitions. Immedia tely after the operation, the nocturnal continence rate was good (79% of patients with a follow up <3 years), reaching 86% after >3 years. A fter 5 years, the reservoir capacity remained within the physiological range (mean volume 469 mL) with a mean maximum internal pressure of 4 7.6 cmH(2)O, while the mean post-micturition residual volume was 28 mL ; no patient needs to use self-catheterization. Given the short intest inal length used, no metabolic clinical problems have occurred. Conclu sions The concept of using the caecum arose from physiological and ana tomical assumptions, i.e. receptive relaxation, the presence of taenia e and ileocaecal sphincter, Taeniamyotomies can achieve the same goals as detubularization, i.e. a reduction of wall tension and internal pr essure and a near-spherical shape, but, in contrast, by leaving the ci rcular muscle intact, they allow a good basal tone to be maintained th us obtaining optimal emptying and avoiding deterioration of the reserv oir.