Rectal vesico-urethroplasty updated with ten years' evaluation.

Area of Science:

• Urology
• Surgical Innovation
• Reconstructive Surgery

Background:

• Total cystectomy necessitates bladder reconstruction to restore urinary function.
• Existing methods like colocystoplasty have limitations in achieving normal continence and voiding.
• Preserving the nerve supply is crucial for bladder reservoir and outlet function.

Purpose of the Study:

• To introduce and evaluate a novel surgical technique, rectal vesico-urethroplasty.
• To assess the ability of this new procedure to replicate normal lower urinary tract anatomy and physiology.
• To compare the outcomes of rectal vesico-urethroplasty with existing reconstructive methods.

Main Methods:

• Rectal vesico-urethroplasty was performed on 126 patients (114 male, 12 female).
• The procedure utilizes the rectum, preserving its nerve supply, to replace the bladder and posterior urethra.
• It was applied as an immediate reconstruction in 111 cases and secondary reconstruction in 15 cases.

Main Results:

• Rectal vesico-urethroplasty demonstrated significantly superior results compared to colocystoplasty.
• Most patients achieved near-normal urinary continence and voiding capabilities.
• Subsequent complications were infrequent, and the postoperative mortality rate, though initially high, was reduced in later cases.

Conclusions:

• Rectal vesico-urethroplasty is a highly effective technique for lower urinary tract reconstruction after total cystectomy.
• The procedure successfully restores both reservoir and sphincteric functions by utilizing the innervated rectum.
• This method offers a significant improvement over previous reconstructive approaches, enhancing patient quality of life.