Anatomic variations in patients operated for bladder substitution

Authors review the anatomic variations observed throughout orthotopic ileal neobladder formation in 38 cases following radical cystectomy. A part of the variations was necessitated because of deviation from the classic Hautmann-type surgical technique: in 6 cases the site of ileal resection was modified due to abnormal mesenterial art. course, on 2 occasions Meckel diverticules were detected while cutting the ileal neobladder, in 13 cases the laterally adhered sigma bladder necessitated the left-sided ureter to be pulled through beneath the mesosigma for the purpose of making sure the ureter--ileal neobladder anastomosis became free of any tension, while on 1 occasion the left ureteral preparations went with some injury. Since the left ureter became short, ureter replacement variation was needed, similar to the Studer method of ileal neobladder formation. All these variations, however, did not implicate the essence of the Hautmann technique. Follow-up of the patients did not reveal high frequency of occurrence of any complications.