Total bladder replacement in the male and female using the ileocolonic segment (LeBag)

A group of 11 patients, 2 female and 9 male, underwent total bladder replacement using the ileocolonic segment (LeBag technique) with anastomosis of the bowel to the urethra. The diagnosis was invasive bladder cancer in 10 patients and severe intractable interstitial cystitis in 1. The surgical technique in the male patients was modified to simplify the procedure. The 2 female patients underwent insertion of an artificial sphincter around the bowel segment for a continence mechanism. One patient died 6 weeks post-operatively from a severe coagulopathy. Five of the 9 male patients are continent day and night, relying on their own residual sphincter mechanism, but the remaining 4 required insertion of the artificial urinary sphincter to achieve social continence. The surviving female patient is totally continent. All patients have voiding intervals of 4 to 6 h during the day and are thus continent both day and night, but in some cases the artificial sphincter was necessary to achieve this. Loss of the normal bladder-sphincter reflexes following cystectomy may account for the high incidence of nocturnal incontinence observed in most series. Total bladder replacement is now possible in both male and female patients, thus avoiding an abdominal stoma.