title: Spontaneous rupture of orthotopic detubularized ileal bladder replacement: report of 5 cases.
abstract: OBJECTIVE
  We defined the mechanisms responsible for rupture of orthotopic, detubularized ileal bladder replacement.
  
  
  METHODS
  We reviewed retrospectively the records of 5 cases of ileal neobladder rupture treated at our center between 1985 and 1995.
  
  
  RESULTS
  The interval to perforation varied from 3 to 60 months after surgery. The perforation site was typically the upper part of the right limb of the reservoir. We observed an acute episode of bladder over distension immediately before perforation in 2 cases and a chronic state of neobladder over distension in the 3 remaining cases. Bacterial infection was associated in 4 cases. Intraperitoneal adhesions were an associated mechanism for rupture in only 1 case. We found chronic ischemic changes weakening the bladder wall to be an additional factor for rupture in the 3 cases associated with chronic over distension.
  
  
  CONCLUSIONS
  Acute or chronic over distension of the neobladder is the main factor for spontaneous rupture of orthotopic detubularized ileal bladder replacement. Chronic ischemic changes of the bladder wall, possibly facilitated by detubularization and the variability of the mesenteric circulation, are additional factors that lead to perforation.
authors.affiliation: Department of Urology, Saint-Louis Hospital, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Desgrandchamps
authors.forename: G
authors.initials: G
authors.lastname: Cariou
authors.forename: Y
authors.initials: Y
authors.lastname: Barthelemy
authors.forename: C
authors.initials: C
authors.lastname: Boyer
authors.forename: P
authors.initials: P
authors.lastname: Teillac
authors.forename: A
authors.initials: A
authors.lastname: Le Duc
mesh_terms: D000368:Aged; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D016476:Urinary Reservoirs, Continent