Modified ileal neobladder for continent urinary diversion: experience and results

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.

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.

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%).

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.