PTU - Polskie Towarzystwo Urologiczne
list of articles:

Ureteroenteric anastomosis in orthotopic ileal neobladder
Article published in Urologia Polska 2006/59/2.

authors

Marko Babjuk, Viktor Soukup, Tomáš Hanuš, Ivan Pavlík, Libor Šafařík, Jan Dvořáček, Petr Macek

keywords

orthotopic ileal neobladder u ureteroenteric anastomosis, reflux prevention, direct reflux technique

summary

Background and the aim of the study. To evaluate the results of direct reflux ureteroenteric anastomosis in patients with orthotopic ileal neobladder
Material and methods. Since 2001 the orthotopic bladder substitution using a preterminal ileal segment of 50-60 cm has been performed in 12 female and in 39 male patients. The ureters were implanted into an afferent segment using a direct anastomosis. In 45 patients a Wallace I end-to-end modification and in 6 patients an end-to-side Nesbit anastomosis were performed.
Results. No early complications that can be attributed directly to the ureterointestinal anastomosis were seen. During the follow-up the stricture of the ureteroileal anastomosis occurred in 5 of 51 patients (9.8%) in 5 of 101 ureteric units (4.95%). The stenosis was on the left side in 4 patients and on the right side in one case only. In all cases the stricture appeared during the first year after surgery.
Conclusions. The direct ureteroenteric anastomosis into the afferent limb of orthotopic ileal neobladder is a safe method associated with a low stricture rate. Currently it is considered as a method of choice in large capacity and low pressure orthotopic ileal neobladders.

references

  1. Hautmann RE: Urinary diversion: ileal conduit to neobladder. J Urol 2003, 169, 834-842
  2. Pantuck AJ, Han K-R, Perrotti M et al: Ureteroenteric anastomosis in continent urinary diversion: long-term results and complications of direct versus nonrefluxing techniques. J Urol 2000, 163, 540-455.
  3. Le Duc A, Camey M, Teillac P: An original antireflux ureteroileal implantation technique: long-term follow up. J Urol 1987, 137, 1156-1158.
  4. Thüroff JW, Alken P, Riedmiller H et al: 100 cases of Mainz pouch: continuing experience and evolution. J Urol 1988, 140, 283-288.
  5. Wallace DM: Ureteric diversion using a conduit: a simplified technique. Br J Urol 1966, 38, 522-527.
  6. Nesbit RM: Ureterosigmoid anastomosis by direct elliptical connection: a preliminary report. J Urol 1949, 61, 728-734.
  7. Goodwin WE, Harris AP, Kaufman JJ, Beal JM: Open, transcolonic ureterointestinal anastomosis. A new approach. Surg Gynecol Obstet 1953, 97, 295-300.
  8. Shaaban A, Gaballah MA, El-Diasty TA, Ghoneim MA: Urethral controlled bladder substitution: a comparison between the intussuscepted nipple valve and the technique of Le Duc as antireflux procedures. J Urol 1992, 148, 1156-1161.
  9. Roth S, van Ahlen H, Semjonow A et al: Does the success of ureterointestinal implantation in orthotopic bladder substitution depend more on surgeon level of experience or choice of technique? J Urol 1997, 157, 56-60.
  10. Hautmann RE, De Petriconi R, Gottfried H-W et al: The ileal neobladder: complications and functional results in 363 patients after 11 years of followup. J Urol 1999, 161, 422-428.
  11. Muraishi O, Yamashita T, Ishikawa S et al: Improvement of ureteroileal anastomosis in orthotopic ileal neobladder with modified Le Duc procedure: short submucosal tunnel technique. J Urol 2001, 165, 798-801.
  12. Schwaibold H, Friedrich MG, Fernandez S et al: Improvement of ureteroileal anastomosis in continent urinary diversion with modified Le Duc procedure. J Urol 1998, 160, 718-720.
  13. Abol-Enein H, Ghoneim MA: Functional results of orthotopic ileal neobladder with serous-lined extramural ureteral reimplantation: experience with 450 patients. J Urol 2001, 165, 1427-1432.
  14. Studer UE, Danuser H, Merz VW et al: Experience in 100 patients with an ileal low pressure bladder substitute combined with an afferent tubular isoperistaltic segment. J Urol 1995, 154, 49-56.
  15. Minervini R, Morelli G, Fontana N et al: Functional evaluation of different ileal neobladders and ureteral reimplantation techniques. Eur Urol 1998, 34, 198-202.
  16. Gschwend JE, Volkmer BG, Liske P et al: Type of ureteral anastomosis in orthotopic ileal neobladders ? impact on the rate of hydronephrosis and renal function. J Urol 2005, 173, Suppl, 132, 481A.
  17. Shaaban AA, Abdel-Latif M, Mosbah A, Eraki I: A randomized study comparing an antireflux system with a direct uretero-intestinal anastomosis in patients with orthotopic ileal neobladders. J Urol 2005, 173, Suppl, 132, 482A.
  18. El-Mekresh M, Franzaring L, Wöhr M et al: Simplified orthotopic ileocecal pouch (Mainz pouch) for bladder substitution. Aktuel Urol 2003, 34, 226-230.
  19. Hollowell CMP, Christiano AP, Steinberg GD: Technique of Hautmann ileal neobladder with chimney modification: interim results in 50 patients. J Urol 2000, 163, 47-51.
  20. Brod?ák M, Hafuda A, Morávek P et al: Kontinence moči u pacientů s ortotopickou neovezikou po cystektomii. Česká Urologie 2005, 9, 4-8.
  21. Jarolím L, Babjuk M, Hanuš T et al: Ortotopická náhrada močového měchýře u ženy po cystektomii se zachováním uretry. Rozhledy v chirurgii 1996, 75, 222-226.

correspondence

Marko Babjuk, MD
Urologická klinika VFN
Ke Karlovu 6
128 08 Praha 2
tel.: +420224967848
marko.babjuk@lf1.cuni.cz