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[Our technique in orthotopic neobladder]
C Del Boca1, D Colloi, A Guardamagna
1Divisione di Urologia, Ussl n. 56, Lodi.
Summary
This study introduces a novel orthotopic neobladder technique for advanced bladder cancer patients, simplifying surgery and improving outcomes. The method offers rapid preparation and reduced complication risks, enhancing patient quality of life.
Area of Science:
- Urology
- Surgical Oncology
- Reconstructive Surgery
Background:
- Orthotopic neobladders aim to improve functional outcomes and surgical simplicity after radical cystectomy.
- Current techniques face challenges in morphofunctional aspects and procedural complexity.
Purpose of the Study:
- To present a modified orthotopic neobladder technique using staplers for advanced bladder cancer patients.
- To evaluate the surgical simplicity, speed, and clinical/urodynamic outcomes of this new method.
Main Methods:
- A modified Camey 2 type neobladder was created using 50 cm of ileum, with 30 cm detubularized and shaped using staplers.
- Ureteral anastomosis was performed using a Wallace 1 type procedure with an isoperistaltic ileal segment.
- Patient selection criteria and a follow-up diagnostic algorithm (biochemical, echographic, radiological, pressure studies) were established.
Main Results:
- The technique allowed for rapid neobladder preparation, reducing overall operating time.
- An isoperistaltic segment for ureteral anastomosis minimized mobilization and reduced reflux probability.
- The study reported satisfactory clinical and urodynamic results, with attention to diurnal/nocturnal continence and voiding intervals.
Conclusions:
- This stapler-assisted orthotopic neobladder technique is surgically simple and rapid.
- It offers satisfactory clinical and urodynamic outcomes for patients undergoing radical cystectomy.
- The procedure allows for potential reconversion to an ileal conduit if necessary.