Bladder replacement by ileocystoplasty after cystectomy for cancer: comparison of two techniques.
OBJECTIVE
To compare two methods of connecting the ureters to an ileocystoplasty.


METHODS
Eighteen men with bladder cancer underwent radical cystoprostatectomy and a further two had a subtotal cystectomy, all with immediate orthotopic bladder replacement by ileocystoplasty. In 10 patients, the ureters were connected to the neobladder by a length of ileum with an inverted nipple valve, while in the other 10 the ureters were implanted directly using a serosal tunnel. Post-operatively, the upper tracts were examined by intravenous urography and the neobladder by cystography before removal of the catheter.


RESULTS
The direct implantation technique used 15 cm less ileum and took a mean of 1 h less operating time to complete. The kidneys and ureters remained normal in all patients except one, who had a subtotal cystectomy and developed severe hydronephrosis and hydroureter with acute renal failure when the inverted nipple valve became everted.


CONCLUSIONS
Whilst both techniques gave satisfactory results, direct implantation is more economical in the length of ileum used and in operating time.
Hendry
W F
WF
St Bartholomew's and Royal Marsden Hospitals, London, UK.
D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D007082:Ileum / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011468:Prostatectomy / Q000379:methods; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery; D016476:Urinary Reservoirs, Continent / Q000379:methods*; D014567:Urography / Q000379:methods