ORTHOTOPIC BLADDER REPLACEMENT IN IRRADIATED FEMALE-PATIENTS

The terminal ileum, ileocecal valve, cecum, and detubularized ascendin g colon were used to form an orthotopic bladder replacement in previou sly irradiated patients. This technique also facilitates easy conversi on of the neobladder to an ileal conduit in unsuccessful cases. The te chnique was used in 15 previously irradiated recurrent cervical cancer patients as part of their pelvic exenteration. Twelve out of 15 patie nts became continent and capable of voiding voluntarily without residu al volume. In three cases the anastomosis between the neobladder and t he urethra broke down. In two of these three cases the orthotopic neob ladder was converted to an ileocecal conduit. The one remaining patien t is alive with urethrovaginal fistula: she has not undergone any furt her surgery. Three patients have developed recurrent disease in the fo llowup period, and two of them died of their disease. The orthotopic b ladder replacement method described may be used in selected high-risk patients for reconstruction of the lower urinary tract.