Objectives: To describe the surgical technique we currently use for the construction of an orthotopic ileal neobladder. We report our experience and functional results of the first 35 cases.
Methods: Since 1993, 35 men have been treated with an ileal neobladder substitute after cystoprostatectomy for bladder cancer. According to the technique we call "a modified S-ileal neobladder," we place emphasis, first, on the complete detubularization of a smaller segment of bowel and its folding in an S configuration without creating a nipple mechanism, and second, on an oblique intramural ureteral reimplantation.
Results: The mean postoperative observation time was 38.2 months (range 6 to 72). No perioperative or early postoperative mortality was observed, and few serious early complications have occurred. Late complications included local tumor recurrence and distant metastases in 1 patient (2.8%) and a vesicoileal fistula requiring surgical correction in 1 patient (2.8%). As of February 2000, a total of 29 patients (82.8%) were emptying their neobladder by relaxation of the urethral sphincter mechanism and/or passive expression of the neobladder by abdominal straining. Six patients (17.1%) required clean intermittent catheterization. Daytime continence was attained in 31 patients (88.5%) and nocturnal incontinence was noted in 9 (26%).
Conclusions: Several techniques may be used to create an ileal neobladder. A neobladder constructed using a smaller part of ileum that has been completely detubularized and folded in an S configuration without a nipple is easy to perform, has acceptable complication rates, achieves adequate capacity at low pressure, and provides satisfactory continence rates.