Bladder replacement by detubularized ileal loop: 10 years of experience using a personal technique

Area of Science:

• Urology
• Surgical Innovation
• Gastrointestinal Surgery

Background:

• Bladder cancer and other conditions necessitate bladder replacement.
• Orthotopic bladder replacement aims to restore natural voiding function.
• Detubularized ileal segments offer potential for neobladder construction.

Purpose of the Study:

• To assess the efficacy and outcomes of a specific detubularized ileal tract technique for orthotopic bladder replacement.
• To evaluate patient continence, functional capacity, and metabolic status following this neobladder procedure.

Main Methods:

• 34 patients underwent orthotopic bladder replacement using a 35-40 cm detubularized, S-shaped ileal segment.
• Ureters were anastomosed to an afferent loop for anti-reflux; an efferent loop was used for urethral anastomosis.
• Mean follow-up was 32 months, assessing continence and post-void residual volumes.

Main Results:

• All patients achieved daytime urinary continence with socially acceptable voiding intervals.
• Nighttime continence was achieved in 10 of 12 patients at 3 years, with 2-4 hour intervals.
• Mean post-void residual urine volume was 41 mL; no patients required self-catheterization or experienced metabolic derangements.

Conclusions:

• The detubularized ileal neobladder technique demonstrates excellent functional outcomes and patient satisfaction.
• Constructing the neobladder with an initial capacity under 120 mL promotes long-term reservoir health and capacity increase.
• Mesenteric triplication aids in maintaining neobladder sphericity and pelvic support, preserving anatomical position.