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The ileal neobladder.

R E Hautmann1, G Egghart, D Frohneberg

  • 1Division of Urology, University of Ulm, Federal Republic of Germany.

The Journal of Urology
|January 1, 1988
PubMed
Summary
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This study presents an ileal neobladder for bladder replacement after radical cystectomy. The technique creates a low-pressure urinary reservoir with high capacity and good compliance, offering a stoma-free alternative.

Area of Science:

  • Urology
  • Surgical Innovation
  • Reconstructive Surgery

Background:

  • Radical cystectomy for bladder cancer necessitates urinary diversion.
  • Traditional diversions often involve stomas, impacting quality of life.
  • Developing continent, low-pressure urinary reservoirs is a key surgical goal.

Purpose of the Study:

  • To evaluate the efficacy and safety of a novel ileal neobladder technique for total bladder replacement.
  • To assess the urodynamic characteristics and functional outcomes of this neobladder construction.

Main Methods:

  • A 70 cm ileal segment was used to create a spherical neobladder, disrupting peristalsis via an antimesenteric longitudinal incision.
  • The neobladder was anastomosed to the urethra, with ureters implanted using the Le Duc and Camey methods.

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  • Videourodynamic studies were performed to assess reservoir capacity, compliance, and reflux postoperatively.

    • Main Results:

    • The neobladder demonstrated a capacity approximating normal bladder function.
    • Good compliance was achieved, maintaining filling pressures below 30 cm water, with no reflux observed.
    • 8 of 11 patients achieved complete dryness (day and night); 3 had Grade I stress incontinence.
    • All patients reported recognizable sensations of bladder distension.

    Conclusions:

    • This ileal neobladder technique provides a viable, stoma-free alternative for urinary diversion in male patients undergoing radical cystectomy.
    • The constructed neobladder functions as a low-pressure, highly compliant urinary reservoir with preserved sensation.