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Bladder replacement by ileocystoplasty after cystectomy for cancer: comparison of two techniques
1St Bartholomew's and Royal Marsden Hospitals, London, UK.
Objective:
To compare two methods of connecting the ureters to an ileocystoplasty.
Patients And Methods:
Eighteen men with bladder cancer underwent radical cystoprostatectomy and a further two had a subtotal cystectomy, all with immediate orthotopic bladder replacement by ileocystoplasty. In 10 patients, the ureters were connected to the neobladder by a length of ileum with an inverted nipple valve, while in the other 10 the ureters were implanted directly using a serosal tunnel. Post-operatively, the upper tracts were examined by intravenous urography and the neobladder by cystography before removal of the catheter.
Results:
The direct implantation technique used 15 cm less ileum and took a mean of 1 h less operating time to complete. The kidneys and ureters remained normal in all patients except one, who had a subtotal cystectomy and developed severe hydronephrosis and hydroureter with acute renal failure when the inverted nipple valve became everted.
Conclusions:
Whilst both techniques gave satisfactory results, direct implantation is more economical in the length of ileum used and in operating time.