New uretero-ileal anastomosis technique in Hautmann ileal bladder replacement

Objective: Hautmann neobladder is one of the most widely bladder replacemen t techniques in the two sexes. The uretero-ileal stenosis rate is estimated to be 11% with the initial CAMEY-LE DUC technique. A new anastomosis techn ique is presented in order to improve this postoperative complication. Materials and Methods: Two 5 to 10 cm ileal segments are prepared at the tw o extremities of the W of the neobladder to receive the largely spatulated ureters. The anastomosis is performed directly on the ileal resection margi n, in a strictly retroperitoneal position. Between December 1996 and Decemb er 1998, the technique was performed in 89 patients including 19 women. One hundred and sixty renal units (RU) were analysed by preoperative renal ult rasound, repeated after 1, 3 and 6 months and then every 6 months. Urine cu lture was performed monthly for 6 months. Results: Thirteen RU were dilated (grade II and III) preoperatively (7.8%). No secondary anastomotic stenosis was observed with a mean follow-up of 5. 8 +/- 7.6 months. Of the 166 RU examined, 129 were normal, 13 preoperative dilatations were improved and 24 RU presented minimal postoperative dilatat ion (grade I). Ileo-ureteric reflux was observed on the postoperative retro grade cystography in two cases. The only complication was acute pyelonephri tis (1.1%) at 1 month. 90% of urine cultures were sterile after 6 months. Conclusion: Modification of uretero-ileal anastomosis by the "double chimne y" technique is performed without tension by placing the two ureters in an anatomical position without plication or torsion. Preservation of the urete ric blood supply contributes to the low complication rate and a decreased r isk of stenosis. Honer rt: the technique needs to he validated by analysis of the results with a longer follow-up.