SPONTANEOUS RUPTURE OF ORTHOTOPIC DETUBULARIZED ILEAL BLADDER REPLACEMENT - REPORT OF 5 CASES

Purpose: We defined the mechanisms responsible for rupture of orthotop ic, detubularized ileal bladder replacement. Materials and Methods: We reviewed retrospectively the records of 5 cases of ileal neobladder r upture treated at our center between 1985 and 1995. Results: The inter val to perforation varied from 3 to 60 months after surgery. The perfo ration site was typically the upper part of the right limb of the rese rvoir. We observed an acute episode of bladder over distension immedia tely before perforation in 2 cases and a chronic state of neobladder o ver distension in the 3 remaining cases, Bacterial infection was assoc iated in 4 cases. Intraperitoneal adhesions were an associated mechani sm for rupture in only 1 case. We found chronic ischemic changes weake ning the bladder wall to be an additional factor for rupture in the 3 cases associated with chronic over distension.Conclusions: Acute or ch ronic over distension of the neobladder is the main factor for spontan eous rupture of orthotopic detubularized ileal bladder replacement. Ch ronic ischemic changes of the bladder wall, possibly facilitated by de tubularization and the variability of the mesenteric circulation, are additional factors that lead to perforation.