[Ileal low pressure bladder substitute with a tubular afferent limb: report of two cases]

We anastomosed the ileal reservoir to the membranous urethra in 2 male bladder cancer patients accepted for total cystectomy. Construction of the reservoir was performed according to Studer et al. (Br J Urol 63: 43-52, 1989). The procedure entails the use of 60 cm of ileal segment. The proximal segment, 15 cm, was left tubular to act as the inflow urinary tract. Anastomosis of the ureters to a tubular afferent ileal limb was carried out by end to side without anti-reflux method. The renal function was not changed by the operation. More than one year after the operation, urodynamic evaluation showed the reservoir to be low pressure with a capacity that increased to more than 400 ml. In both cases, however, about 300 ml residual urine was observed. Now both patients are performing intermittent self-catheterization and are continent night and day. When considering quality of life, this procedure is suitable whenever the urethra can be preserved after total cystectomy. For making a more "natural" bladder substitute, however, some modification of the operative procedure including anti-reflux system may be required.