title: The ileocaeco-urethrostomy with multiple transverse taeniamyotomies for bladder replacement: an alternative to detubularized neobladders. Morphological, functional and metabolic results after 9 years' experience.
abstract: OBJECTIVE
  To evaluate the results from the long-term follow-up of ileocaeco-urethrostomy with multiple transverse taeniamyotomies for bladder replacement.
  
  
  METHODS
  Since 1987, 60 male patients have undergone bladder replacement using a technique of ileocaeco-urethrostomy with multiple transverse taeniamyotomies. Avoiding detubularization, sectioning the caecal taeniae improved reservoir morphology and reduced internal pressures and wall tension, limiting the potential complications of the operation.
  
  
  RESULTS
  All patients achieved diurnal continence with socially acceptable intervals between micturitions. Immediately after the operation, the nocturnal continence rate was good (79% of patients with a follow up < 3 years), reaching 86% after > 3 years. After 5 years, the reservoir capacity remained within the physiological range (mean volume 469 mL) with a mean maximum internal pressure of 47.6 cmH2O, while the mean post-micturition residual volume was 28 mL; no patient needs to use self-catheterization. Given the short intestinal length used, no metabolic clinical problems have occurred.
  
  
  CONCLUSIONS
  The concept of using the caecum arose from physiological and anatomical assumptions, i.e. receptive relaxation, the presence of taeniae and ileocaecal sphincter. Taeniamyotomies can achieve the same goals as detubularization, i.e. a reduction of wall tension and internal pressure and a near-spherical shape, but, in contrast, by leaving the circular muscle intact, they allow a good basal tone to be maintained thus obtaining optimal emptying and avoiding deterioration of the reservoir.
authors.affiliation: Universita Cattolica del Sacre Cuoro, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Alcini
authors.forename: M
authors.initials: M
authors.lastname: Racioppi
authors.forename: A
authors.initials: A
authors.lastname: D'Addessi
authors.forename: A
authors.initials: A
authors.lastname: Alcini
authors.forename: P
authors.initials: P
authors.lastname: Menchinelli
authors.forename: F
authors.initials: F
authors.lastname: Grassetti
authors.forename: A
authors.initials: A
authors.lastname: Destito
authors.forename: F
authors.initials: F
authors.lastname: Sasso
authors.forename: M
authors.initials: M
authors.lastname: Giustacchini
mesh_terms: D000368:Aged; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D002432:Cecum / Q000637:transplantation*; D015653:Cystectomy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D001749:Urinary Bladder Neoplasms / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology; D016476:Urinary Reservoirs, Continent; D014563:Urodynamics