M-shaped orthotopic ileal neobladder (report of 42 cases) / 中华泌尿外科杂志

ABSTRACT

Objective To evaluate the outcomes of M-shaped orthotopic ileal neobladder. Methods A total of 42 male patients with malignant bladder tumors underwent M-shaped orthotopic ileal neobladder after extraperitoneal total cystoprostatectomy.A segment of 45 to 50cm ileal loop was isolated,detubularized,and reconfigured in “M”- shape to form a pouch.Bilateral ureters were reimplanted by means of inserting the 1 cm distal segment into the pouch.The bottom of pouch was opened and anastomosed with the urethra. Results The 42 patients were followed up for 12 to 96 months with a mean of 44 months.38 cases(90.5%) were well continent during daytime,and 36 cases(85.7%) were continent at night.The volume of the pouch was (361?48)ml at 12 months postoperatively. Urodynamic examination showed that the peak voiding pressure was (86.8?21.4)cm H 2O(1 cm H 2O=0.098 kPa).The maximum flow rate (Q max ) was(18.4?6.1)ml/s.No remarkable ureter reflux and obstruction were found.No patient was detected to develop recurrent urethral carcinoma. Conclusions Extraperitoneal cystectomy can prevent the abdomen from tumor contamination and protect the operative field from intestine interference.The ureter-inserting reimplantation technique is a simple anti-reflux anastomosis with lower rate of ureteral stenosis.Isolating the neobladder and ureters from the peritoneal cavity can reduce the postoperative complications of adhesive ileus,internal hernia,and urine leakage to peritoneal cavity.The neobladder is similar to original bladder in position,volume,shape,and anti-reflux of ureter connection.