Modified ileal neobladder for continent urinary diversion: Experience and results

Objectives. To describe the surgical technique we currently use for the con struction of an orthotopic ileal neobladder. We report our experience and f unctional results of the first 35 cases, Methods. Since 1993, 35 men have been treated with an ileal neobladder subs titute after cystoprostatectomy for bladder cancer. According to the techni que we call "a modified S-ileal neobladder," we place emphasis, first, on t he complete detubularization of a smaller segment of bowel and its folding in an S configuration without creating a nipple mechanism, and second, on a n oblique intramural ureteral reimplantation. Results. The mean postoperative observation time was 38.2 months (range 6 t o 72). No perioperative or early postoperative mortality was observed, and few serious early complications have occurred. Late complications included local tumor recurrence and distant metastases in 1 patient (2.8%) and a ves icoileal fistula requiring surgical correction in 1 patient (2.8%). As of F ebruary 2000, a total of 29 patients (82.8%) were emptying their neobladder by relaxation of the urethral sphincter mechanism and/or passive expressio n of the neobladder by abdominal straining. Six patients (17.1%) required c lean intermittent catheterization. Daytime continence was attained in 31 pa tients (88.5%) and nocturnal incontinence was noted in 9 (26%). Conclusions. Several techniques may be used to create an ileal neobladder. A neobladder constructed using a smaller part of ileum that has been comple tely detubularized and folded in an S configuration without a nipple is eas y to perform, has acceptable complication rates, achieves adequate capacity at low pressure, and provides satisfactory continence rates. (C) 200 1, El sevier Science Inc.