Orthotopic continent urinary diversion an ileal low pressure neobladder with an afferent tubular segment: how I do it.
The surgical technique described here is not more complex than that of an ileal conduit but has significant advantages. The aboral end of an isolated portion of the distal ileum is formed into a low pressure, high capacity bladder substitute that combines Goodwin's 'cup-patch' technique and Couvelaire's ileo-urethral anastomosis. Although the neobladder is constructed from only about 40 cm of ileum, it achieves a capacity of 500 ml within a few weeks, simultaneously with rapid improvement of urinary incontinence. The procedure described is easy to perform and its long-term functional results have passed the test of time. Aside from the surgical technique per se, success with this method of bladder substitution is mainly ascribed to meticulous postoperative care and follow-up.
Perimenis
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Department of Urology, Inselspital University Hospital, Berne, Switzerland. perimenis@internet.gr
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D002295:Carcinoma, Transitional Cell / Q000601:surgery; D015653:Cystectomy; D006801:Humans; D007082:Ileum / Q000637:transplantation; D011182:Postoperative Care; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent; D013520:Urologic Surgical Procedures / Q000379:methods*