The Ileal Neobladder

Abstract

An ileal neobladder for total bladder replacement was created in 11 patients. To achieve a low pressure system, disruption of directional bowel peristalsis with a longitudinal incision at the antimesenteric border of a 70 cm. ileal segment is performed. A spherical pouch, the neobladder, is fashioned and anastomosed to the urethra. The ureters are implanted according to the method of Le Duc and Camey. Videourodynamic studies during various postoperative phases demonstrate this neobladder to be a urinary reservoir with a capacity approximating that of a normal bladder, good compliance during filling by maintaining pressure lower than 30 cm. water and no reflux. Of the 11 patients with the neobladder 8 are completely dry day and night, while 3 have grade I stress incontinence. All 11 patients had recognizable sensations of bladder distension closely simulating those of normal bladders. The use of this ileal neobladder in male patients undergoing radical cystectomy offers an alternative free of a stoma to urinary diversion, resulting in a highly compliant, low pressure bladder.

Modified Ghoneim’s Technique Using a Single Serous–Lined Extramural Tunnel in Detubularized Orthotopic Ileal W–Bladder

“…The neobladder was prepared using a 50–cm segment of ileum which was detubularized and formed into a ‘W’ shape as described by Hautmann et al [6]. The serosa of the adjacent limbs of the ileal segment were opposed on the right part of the double ‘W’ by continuous serosa–muscular anastomosis, using slow absorbable 3–0 material, to form the back wall of a serous–lined tunnel.…”

Rotundovaginopexy in Orthotopic Ileal Neobladder following Radical Cystectomy in Women

“…Thus a fixed broad plate is created, arming the posterior wall of the neobladder. The neobladder is built as described by Hautmann et al [1, 7] and Pagano et al [13]. Creation of the neobladder and anastomosis to the urethra are not impaired by rotundovaginopexy.…”

“…The ileal neobladder has been widely used after radical cystectomy in men [1, 2, 3, 4]. Only in the last years have orthotopic neobladders been successfully used for women, if the trigone and bladder neck were free of tumor [5, 6, 7, 8, 9, 10, 11].…”

The Ileal Neobladder — An Ideal Bladder Substitute?

“…The technique adopted was as described by Hautmann and associates in 1988 [2]. An ileal segment, 70 em long, was isolated about 20 em away from the ileocecal junction.…”

“…The neobladder created from detubularized ileum is appealing as it incorporates all the above features. The technique as originally described in 1988 by Hautmann and associates [2] has only recently caught the imagination of urologists in India. Infrequently done because of the demanding nature of the surgery, experience is limited to major Indian urology centers.…”