Spontaneous late rupture of orthotopic detubularized ileal neobladders: Report of five cases

Objectives. To report five spontaneous ruptures in 4 patients. Spontaneous late rupture of orthotopic ileal bladder replacements is a rare complicatio n of continent urinary diversion. Methods. Four recurrence-free patients aged 36 to 68 years experienced appa rently spontaneous rupture of continent orthotopic ileal bladder replacemen t 3 months to 3 years after curative radical cystectomy and urinary diversi on for invasive bladder cancer. Ileal bladder rupture occurred twice in 1 p atient with an interval of 9 months. Results. All 4 patients had had a good result from their diversion procedur e and had reported complete day and nighttime continence before the spontan eous rupture. The spontaneous rupture was evidently caused by overdistensio n of the ileal neobladder in four of five instances. In addition to overdis tension, a second factor such as minor blunt abdominal trauma or urethral o cclusion was identifiable in two instances. The rupture occurred in the rig ht upper corner of the ileal bladder in four of five instances and led to a cute and severe abdominal pain. Cystography was done in three instances, bu t was diagnostic in only 2 cases. The histologic examination of the excised bladder wall margins revealed nonspecific inflammatory changes in 3 cases. Open surgical drainage and repair was successfully undertaken in all cases . Conclusions. The circumstances of the cases described suggest that late spo ntaneous rupture of an orthotopic ileal bladder replacement is not related to the surgical technique but rather to factors of patient compliance and m edical management. UROLOGY 58: 43-46, 2001. (C) 2001, Elsevier Science Inc.