THE HAUTMANN NEOBLADDER WITH A CHIMNEY - A VERSATILE MODIFICATION

Purpose: We describe a modification to the popular Hautmann ileal neob ladder comprised of a chimney for the ureterointestinal anastomosis in order to enhance its flexibility, reduce its pitfalls and hence make more patients candidates for this type of diversion. Materials and Met hods: The Hautmann ileal neobladder is prepared in the standard fashio n except that an additional 5 to 90 cm, (or more if needed in the case of a short ureter) of small bowel are selected to be added for either a left or right ''chimney'' (depending on which side the ureter may b e shorter or if there is a solitary kidney). The V segment of the W wh ich will be anastomosed to the urethra is made longer than the contral ateral V segment. A neobladder neck is created by sewing together the cut edges of a 5 cm. lip in the lowermost W configuration of the neobl adder, allowing an end-to-end urethrointestinal anastomosis. Results: Between March and. October 1996, 3 patients have undergone this proced ure at the University of Virginia. Two had right chimneys and 1 had a left chimney. Followup is short, but there have been no complications except for a transient postoperative partial small bowel obstruction i n 1 patient. Two patients have no urinary incontinence, the third has only occasional nocturnal incontinence. Conclusions: This modification of the Hautmann ileal neobladder provides greater versatility for sho rt ureters, minimizes tension from the mesentery on the urethrointesti nal anastomosis, simplifies the ureterointestinal anastomosis and prov ides easy postoperative access for ureterointestinal anastomosis revis ion or resection in case of recurrent disease.