title: Radical cystectomy with W-shaped orthotopic ileal neobladder constructed with non-absorbable titanium staples-long term follow-up.
abstract: OBJECTIVE
  We retrospectively assessed our experience with the W-shaped orthotopic ileal pouch, which was constructed with non-absorbable titanium staples. For these purpose, we discuss the results of bladder capacity, urinary continence and early and long-term postoperative complications.
  
  
  METHODS
  We included in the study 17 patients who underwent radical cystoprostatectomy followed by construction of an orthotopic W-shaped ileal pouch between October 2000 and November 2009. A 65-70 cm segment of ileum was isolated and prearranged into a W-configuration, leaving two 10 cm intact segments on both sides of the ileal fragment. In our technique we entirely anatomized all adjacent limbs in order to create a sphere-shaped pouch. The ureters were directly anastomized to both intact segments of the ileal division. All our patients underwent pouchscopy 6 months after operation and annually.
  
  
  RESULTS
  Mean operative time for neobladder reconstruction and ureteral anastomoses was 87 ± 7.67 minutes. In one patient a leak from the ileo-ileal anastomosis was confirmed on the 3rd day after operation. In 2 cases unilateral stricture of the ureteral-neobladder anastomosis was documented. Staple lines were mostly covered with ileal mucosa after 6 months. The mean functional bladder capacity was 340 ± 27.6 mL and 375 ± 43.4 mL at 6 and 12 months, respectively. First-year daytime and nighttime continence was good and acceptable in 90% and 78% of patients, while it increased to 95% during the 2nd year.
  
  
  CONCLUSIONS
  The long term follow-up shows that non-absorbable titanium staples can be safely used for creation of an orthotopic ileal neobladder. However, these data should be further validated in a larger series of patients.
authors.affiliation: Department of Urology and Department of Pathology, Barzilai Med. Center, Ashkelon, Israel. cambell@netvision.net.il
authors.forename: Sergey
authors.initials: S
authors.lastname: Kravchick
authors.forename: Leonid
authors.initials: L
authors.lastname: Lobik
authors.forename: Adrian
authors.initials: A
authors.lastname: Paz
authors.forename: Eugeny
authors.initials: E
authors.lastname: Stepnov
authors.forename: David
authors.initials: D
authors.lastname: Ben-Dor
authors.forename: Shmuel
authors.initials: S
authors.lastname: Cytron
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011468:Prostatectomy / Q000379:methods; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods*; D014025:Titanium; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
chemical_list: D014025:Titanium