The technique of „economic” neobladder creation after radical cystectomy
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Tadeusz Fedus, Janusz Ławiński, Krystyna Pikor, Szczepan Pabiś, Jacek Tereszkiewicz

Wojewódzki Szpital Specjalistyczny w Rzeszowie

summary

Introduction.

Radical cystectomy is the gold standard treatment for muscle-invasive bladder cancer. There are many surgical techniques of bladder reconstructions

using ileum segment. Neither of them is perfect. We present simple method of cystoplasty by using ileal loop for bladder reconstruction, described by Arnulf Stencel in 2005

named “economic” neobladder.

Objectives.

We present technique of “economic” neobladder creation after radical cystectomy – 15 min.

Materials and methods.

After radical cystectomy 40 cm of terminal ileum are isolated and the ileal tube is arranged as a U. Starting 2-3 cm from the endings, running

seromuscular suture of approximately 8 cm at the mesenterial insertion forms a so called “ileal trough”. The ileum is opened at its antimesenteric border in its entire length.

The conjoined ureters (Wallace) are placed into the ileal trough, sutured and buried by closing the ileal flaps. The neobladder is completed by cross folded “U”, suturing and

connection to stamp of urethra.

Results.

After trying several different techniques over the years, the neobladder described here has proven to be “economic” with regards to: 1. bowel length, 2.

efficient in reflux protection of upper urinary tract. 3. Less time consuming than other methods.

Conclusions.

1. This neobladder is “economic” with regard to bowel length utilized (40 cm). 2. The technique of cross folded “U” (Goodwin’s cup patch principle)

combines low pressure with simplicity and short suture lines. 3. Serosa lined extramural implantation achieves an antireflux mechanism and has a low stricture rate. 4. The

Wallace 1 technique of implantation in the middle of the posterior neobladder wall fascilitates endourological especially ureteroscopic procedures. 5. The technique of

“economic” neobladder can be used in female and male, open and laparoscopic operations.