Modified orthotopic ileal neobladder - surgical technique and initial results

Abstract

Introduction/Objective. Vesica ileale Padovana is the surgical technique for reconstruction of lower urinary tract following radical cystectomy using isolated ileal segment. This operative technique requires dissection of both ureters in full length, that can’t be possible in some cases. The paper is aimed to present our experience with modified surgical technique of vesica ileale Padovana using 40 cm of an isolated ileal segment and initial results. Methods. 10 male patients received modified ileal neobladder following radical cystectomy at our institution during the period 2008 to 2011. The mean age of patients was 59 years (45-70). Median follow-up was 76 months (62-93). Patients were monitored cautiously for functional outcome, local recurrence, and distant progression. Results. Perioperative, early and late postoperative mortality have not been noticed. There were only 2 major complications: prolonged postoperative ileus and prolonged urinary leakage requiring percutaneous nephrostomy and subsequent ureteral reimplantation due to stenosis of ureterovesical anastomosis in 1 patient (10 %), respectively. Average ileal neobladder capacity was 450 ml. Daytime and night continence were achieved in 9 (90%) and 7 (70%) of patients, respectively. Conclusion. This modification of orthotopic ileal neobladder has not been difficult to perform in our hands. Modified technique provides a clear advantage in easier ureteral implantation more proximally than in the original technique, requiring less length of ureters. Initial encouraging results should be confirmed in further clinical practice.

Keywords

• urinary bladder neoplasms
• cystectomy
• urinary diversion
• reconstructive surgery