title: Milking action: a new functional concept of a different orthotopic neobladder: 4-year followup.
abstract: OBJECTIVE
  We demonstrate how the combined use of detubularized and remodeled intestine with intact cecum in the construction of an orthotopic colonic neobladder determines different functioning.
  
  
  METHODS
  Since February 1993, 11 men who underwent radical cystectomy due to invasive bladder carcinoma have received a new bladder substitute consisting of an upper component of ascending colon and a detubularized and remodeled right half of transverse colon, and a lower component with intact cecum. During postoperative years 1 and 4 all patients were evaluated with urodynamics and cystography.
  
  
  RESULTS
  The detubularized upper component of the neobladder acts as a large capacity, low pressure filling reservoir, while the intact cecum with its haustral contractions (inverted milking action) contributes as an additional continence mechanism. The mass contractions (milking action) with abdominal wall tension actively collaborate to evacuate the reservoir completely.
  
  
  CONCLUSIONS
  This new structural concept of a neobladder constructed from detubularized and intact intestine has a different functional behavior than neobladders described in literature. This neobladder enables complete evacuation and total continence in the immediate postoperative period.
authors.affiliation: Department of Surgery, Hospital Dr. José Penna, Bahia Blanca, Argentina.
authors.forename: O R
authors.initials: OR
authors.lastname: D'Orazio
authors.forename: O L
authors.initials: OL
authors.lastname: Lambert
authors.forename: J D
authors.initials: JD
authors.lastname: Otranto
authors.forename: J C
authors.initials: JC
authors.lastname: Vallati
authors.forename: F
authors.initials: F
authors.lastname: Franco
authors.forename: C A
authors.initials: CA
authors.lastname: Saenz
mesh_terms: D002432:Cecum / Q000637:transplantation*; D003106:Colon / Q000637:transplantation*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001743:Urinary Bladder / Q000502:physiology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014563:Urodynamics