title: Modified technique for the creation of an orthotopic neobladder in patients with shortened mesentery: making up the difference between the bladder and the urethral stump.
abstract: OBJECTIVE
  To describe an ileal neobladder reconstruction technique performed in 5 men who had previous abdominal surgeries and presented with a short mesoileum at the time of bladder replacement.
  
  
  METHODS
  The patients were 5 men scheduled for a radical cystoprostatectomy with bladder substitution and had a short mesoileum at the time of the surgery. All patients had a history of abdominal surgery. A neobladder was constructed in a "J" shape leaving the most proximal part of the ileum (8-10 cm) tubularized. We created a 3- to 4-cm flap from the surface of the most distal region of the reservoir. This flap was tubularized to lengthen the neobladder onto the urethral stump, resulting in a tension-free anastomosis. All patients underwent a complete clinical laboratory evaluation 12 months after the surgery.
  
  
  RESULTS
  At 1 year after surgery, all patients were able to void spontaneously. Day and night time continence were 80% and 60%, respectively. Urodynamic evaluation revealed a neobladder with good capacity (mean = 521 ml) and compliance (mean = 27.2 mL/cm H(2)O). Only 1 patient demonstrated a moderate hydronephrosis of the right kidney.
  
  
  CONCLUSIONS
  Candidates for orthotopic neobladders who have had previous abdominal surgeries and who have a short mesoileum at the time of the surgery are uncommon. Despite the small number of cases, our technique is noteworthy for having achieved good functional results during the short-term follow-up. This technique is advantageous because it is easy to perform and does not require any other bowel resection or anastomose.
authors: Division of Urology, Department of Surgery and Anatomy, Ribeirao Preto Medical School, Sao Paulo University, SP, Brazil. rodolforeis@fmrp.usp.br
authors: Rodolfo Borges
authors: RB
authors: dos Reis
authors: Roberto Dias
authors: RD
authors: Machado
authors: Eliney Ferreira
authors: EF
authors: Faria
authors: Marcelo
authors: M
authors: Cassini
authors: Steven
authors: S
authors: Kaplan
mesh_terms: D000368:Aged; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps; D014521:Urethra / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*; D014549:Urinary Incontinence / Q000209:etiology; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects; D014563:Urodynamics