Continent urinary diversion and ileal orthotopic neobladder (report of 68 cases) / 中华泌尿外科杂志

ABSTRACT

Objective To evaluate the different methods of continent urinary diversion and the ileal orthotopic neobladder after total cystectomy. Methods 4 different kinds of continent urinary diversion were undertaken after total cystectomy for 68 cases.Continence and catheterization, volume and pressure of the reservoirs, image and hydroelectrolyte condition were investigated. Results Of the 3 cases with intussusceptive efferent tract,2 had partial deintussusception resulting in incontinence and had to be reoperated;44 cases with tapered terminal ileal efferent tract were continent and could be catheterized easily with 16～20F catheters, whereas only one case had difficulty in catheterization. 39 cases with detubularized and reshaped intestinal segment reservoirs, including 3 ileal,22 colonic and 14 ileocolonic, all achieved the demand of low intrareservoir pressure, whereas 8 cases operated in the early period had dilated reservoirs with a volume as large as 1 470～1 650 ml;8 cases with detenia cecocolonic reservoir had the volume of 430～600 ml and as intrareservoir pressure of 30～45 cmH 2O with peristalsis waves,2 of them had urine leakage in the early stage after operation.21 cases with ileal orthotopic neobladder had a volume of 350～480 ml and an intrareservoir pressure of 12～20 cm H 2O.1 being incontinent at daytime and 2 at night whereas all the others were continent. Conclusions Continent urinary reservoirs constructed by 30 cm detubularlized cecocolon can achieve the demand of low intrareservoir pressure.Detenial colonic reservoirs had more chance of urine leakage and adhesion, and higher intrareservoir pressure. Tapered terminal ileal efferent tract is better than ileal intussusception efferent tract for its excellent continence, large caliber, easy catheterization and fewer complications. Ileal orthotopic neobladder has the advantages of excellent continence, higher quality of life, but has limited indications.