[Conversion from Bricker to orthotopic neobladder: A case report]

Bladder cancer (BCa) significantly impacts patients' quality of life, particularly following radical cystectomy (RC) and urinary diversion. A 68-year-old male patient, diagnosed with BCa, underwent RC and Bricker urinary diversion six months prior. Despite successful tumor control, the patient struggled to adapt to the stoma, leading to a decline in his quality of life and increased psychological burden. Recognizing the need for a more satisfactory solution, we explored the feasibility of converting the Bricker diversion to an orthotopic neobladder (ONB), a procedure that promised to restore voluntary urination and enhance patient autonomy. Thorough biochemical and imaging examinations revealed no signs of tumor recurrence. In response to the patient' s strong desire for a better quality of life, a comprehensive assessment was conducted, and laparoscopic conversion from Bricker to ONB was decided upon after in-depth communication with the patient and his family. In this case, we performed a laparoscopic conversion from Bricker to ONB, addressing the complexities associated with prior abdominal surgeries and potential adhesions. The surgical approach involved careful dissection and identification of anatomical structures to minimize complications. Postoperatively, the patient demonstrated remarkable recovery, achieving normal urinary function without complications such as bowel obstruction. He reported a significant improvement in his quality of life, expressing high satisfaction with the surgical outcome. This case highlights the technical feasibility and safety of laparoscopic conversion from Bricker to ONB, providing a viable alternative for patients dissatisfied with their initial urinary diversion methods or experiencing related complications. However, it is essential to note that the success of this individual case does not imply a change in treatment protocols for all patients. The selection criteria for this surgical approach and the management of the surgical process remain subjects of ongoing debate. In conclusion, while laparoscopic conversion from Bricker to ONB is technically feasible, the selection of appropriate candidates for this procedure is still contentious. This surgical option may serve as an alternative for patients who struggle with non-continent urinary diversions or experience complications. Urologists should engage in thorough discussions with patients regarding their options and exercise caution when selecting initial urinary diversion methods to minimize the need for conversion surgeries. Our findings contribute to the evolving landscape of urinary diversion techniques and underscore the importance of personalized patient care.