去带盲结肠可控膀胱术

目的　改进膀胱癌患者膀胱全切后贮尿和排尿问题。　方法　对 2 3例全膀胱切除患者行去带盲结肠可控膀胱术。　结果　 2 2例术后随访 3～ 30个月 ,3个月后贮尿囊容量 45 0～ 6 0 0ml,平均 5 5 0ml,平均内压 (14± 8)cmH2 O(1cmH2 O =0 .0 98kPa) ,贮尿囊造影未见输尿管返流 ,IVU示上尿路无积水和输尿管狭窄 ,排尿控制良好 ,插管容易。　结论　去带盲结肠可控膀胱术是一种较为理想的尿流改道方法 ,具有较好的应用价值。     

阑尾与尿道吻合的回盲肠代膀胱手术远期疗效观察(附11例报告)

目的　评价阑尾与尿道吻合的回盲肠代膀胱手术远期疗效。　方法　应用回盲肠作贮尿囊 ,阑尾代后尿道原位排尿的方法治疗膀胱肿瘤病人 5 6例。　结果　 11例病人术后获 10年以上随访。其中白天完全自控排尿 10例 ,夜间完全自控排尿 8例。伴后尿道假性瓣膜 2例 ,贮尿囊内继发结石 1例 ,后尿道狭窄 1例 ,无输尿管返流 ,无高氯性酸中毒。贮尿囊容量 2 90～ 5 2 0ml,平均 388ml,压力 2 3～ 36cmH2 O(1cmH2 O =0 .0 98kPa) ,平均 2 8cmH2 O。平均尿流率 9.6ml/s。　结论　阑尾与尿道吻合的回盲肠代膀胱术式具有贮尿囊内压低 ,容量大 ,可控性和原位排尿的优点 ,是一种较理想的尿流改道方式。     

原位回肠代膀胱术的疗效观察（附25例报告）

目的：观察7年来行原位回肠代膀胱术的治疗效果。方法：对25例男性膀胱癌患者行膀胱全切回肠代膀胱术。结果：25例患者中有24例获得随访,随访时间2－84个月,平均84个月。手术时间平均240min,输血量平均550ml,手术并发症少,23例患者白天可控制排尿,其中14例夜间自控排尿。3例有肾脏或输尿管积水,2例肾功能异常。膀胱排尿造影均未发现输尿管反流。血生化检查除2例发现低血钾外,其余血电解质均在正常范围。未发现肠膀胱或尿道肿瘤复发。结论：原位回肠代膀胱术是值得选择的尿流改道方式。     

原位回肠新膀胱术15 例临床报告

目的 探讨膀胱全切除术后原位M形回肠新膀胱的疗效.方法 膀胱恶性肿瘤患者15例行膀胱全切除术,采用M形原位回肠新膀胱术进行尿流改道.结果 围手术期无1例死亡,随访3-20个月(平均12.4个月).膀胱容量(340±23.71)mL(210-430 mL),膀胱充盈压为(20.12±0.64)cmH2O(13.50-33.91 cmH2O),排尿膀胱压为(77.02±12.11)cmH2O(53.21-87.09 cmH2O),残余尿(15.43±34.33)mL(3-88 mL),最大尿流率(18.16±5.60)mL/s(11.38-19.17 mL/s).无明显输尿管梗阻及返流.未发现尿道残端复发肿瘤.无排尿困难者,白天均可控制排尿;术后大于6个月者无夜间遗尿,术后半年15例复查B 超无肾积水表现,复查生化指标,肾功能电解质在正常范围内,1例术前肾积水及肾功能异常者术后为正常.结论 原位回肠新膀胱术是较理想的膀胱全切术后的尿流改道方式.     

改良膀胱全切、原位回肠代膀胱术的疗效观察

目的:探讨膀胱根治术后行尿流改道的方法。方法:对17例男性膀胱癌患者行膀胱全切、原位回肠代膀胱术,采用改良的手术方法。结果:手术时间平均230min;输血量平均480ml;全部病例可完全控尿,需夜间定时排尿;膀胱最大贮尿量平均330ml,剩余尿均小于80ml。17例全部随访,时间7～48个月,平均19个月。术后仅发生单侧输尿管反流1例,肾功能衰竭死亡1例,肿瘤转移死亡1例。无电解质紊乱发生,未发现尿道肿瘤复发。结论:改良膀胱全切、原位回肠代膀胱术是膀胱根治术后尿流改道的较为理想术式。     

女性保留内生殖器膀胱全切原位回肠新膀胱尿流改道术的临床疗效

目的:探讨女性保留内生殖器膀胱全切患者行原位回肠新膀胱尿流改道术的临床疗效。方法:回顾性分析我院2005年7月~2012年5月48例女性膀胱肿瘤患者的临床资料,均采取保留内生殖器的膀胱全切术并行原位回肠新膀胱尿流改道术。48例患者中移行细胞癌46例,腺癌2例;原发肿瘤32例,复发性肿瘤16例;多发性非肌层侵犯肿瘤17例,肌层浸润性膀胱肿瘤31例。结果:48例患者的平均手术时间260(210~360)min,平均输血量280(0~1200)ml。术后47例患者获得随访,随访6~84个月,平均36个月。术后12个月白天控尿率为97.9%(46/47),夜间控尿率为93.6%(44/47)。新膀胱尿道吻合口漏3例。术后6个月IVU检查输尿管狭窄2例。无子宫、子宫附件及阴道转移复发。结论:对于符合适应证的女性膀胱癌患者,保留内生殖器、阴道前壁、自主神经及完整尿道,行膀胱全切并行原位回肠新膀胱尿流改道术,临床疗效满意,术后患者生活质量高,可作为广泛开展的术式。     

原位M形回肠代膀胱术42例报告

目的　评价原位M形回肠代膀胱的疗效。　方法　男性膀胱恶性肿瘤患者 4 2例 ,腹膜外切除膀胱前列腺 ,截取 4 5～ 5 0cm回肠纵行剖开后M形折叠形成贮尿囊 ,输尿管插入贮尿囊内 1cm作吻合 ,贮尿囊底部与尿道 6针吻合 ,将贮尿囊完全置于腹膜外。　结果　本组 4 2例 ,术后随访12～ 96个月 ,平均 4 4个月。白天控尿良好者 38例 (90 .5 % ) ,夜间控尿良好者 36例 (85 .7% )。术后 12个月代膀胱容量 (36 1± 4 8)ml,最大排尿压 (86 .8± 2 1.4 )cmH2 O(1cmH2 O =0 .0 98kPa) ,最大尿流率(18.4± 6 .1)ml/s,无明显输尿管梗阻及返流。未发现尿道残端复发肿瘤。　结论　腹膜外切除膀胱可减少腹腔被肿瘤污染 ,避免肠管进入盆腔而影响手术操作。插入式输尿管吻合法 ,操作简单 ,术后形成小乳头有良好的抗返流作用 ,输尿管狭窄发生率低。代膀胱置于腹膜外 ,可减少肠粘连、肠梗阻、输尿管梗阻、腹腔内感染等并发症。改良后的原位回肠代膀胱术式 ,具有手术操作简单、术后并发症少、功能良好的特点 ,代膀胱在位置、形态、容量及输尿管抗返流等方面均接近正常膀胱。     

肠代膀胱术中回肠反套入抗输尿管返流方法的临床研究

目的 评价肠代膀胱术中回肠反套入的抗输尿管返流作用。方法 患者5例，男4例，女1例。年龄48～67岁，平均61岁。均为浸润性移行细胞癌，行膀胱全切、回肠正位膀胱术。距回盲部屈氏韧带15cm处切取回肠30cm，近端回肠反套入4cm，回肠段远端肠管对系膜缘纵形剖开，U形缝合；套入肠管与对应肠片均切除1cm宽之黏膜，相应浆肌层可吸收线固定4针，对应黏膜缘缝合，防止套入肠管滑脱；双侧输尿管远端剖开6cm，侧侧吻合后经套入肠管引入，吻合口与套入肠管口间断缝合；U形肠管对折成储尿囊，与尿道吻合。术后定期行血生化、双肾B超、排泄性膀胱造影和尿动力学检查。结果 5例患者随访10～33个月。排尿次数白天3～5次，夜间0～3次；日间控尿100％，夜间控尿80％；尿动力学检查：最大尿流率9．5～31．5ml／s，膀胱容量350～710ml，平均433ml；剩余尿50～305ml；最大膀胱排尿压23～52cmH2O；膀胱出口无梗阻。B超检查双肾无积水。膀胱造影未见输尿管返流。结论 回肠正位膀胱术中回肠反套入方法有良好的抗输尿管返流作用。     

可控性回盲肠膀胱23例

目的探讨膀胱全切后可控性膀胱的手术方法及术后疗效观察。方法1996年10月至2000年10月对23例膀胱癌患者施行根治性膀胱切除后采用回盲升结肠形成贮尿囊,进行尿流改道。结果随访4月到4年均获得满意的疗效。贮尿囊容量达300～550ml,最大压力40cmH2O,阑尾流出道的压力为54cmH2O,4-5小时导尿1次,无尿外溢,无高氯性酸中毒。有2例术后因肿瘤转移死亡。结论回盲肠袋做贮尿囊,阑尾做流出道,可控性好,并发症少,可提高患者的生存质量,是理想的尿流改道术式。     

肠道新膀胱尿动力学检查的临床意义

目的 探讨全膀胱切除肠代膀胱术后患者新膀胱和尿道的尿动力学特点。方法 全膀胱切除回肠原位新膀胱术患者22例，术后6～55个月，平均28个月。尿动力学检查测定尿流率、剩余尿，充盈期、排尿期膀胱测压、直肠测压、括约肌肌电图和尿道压测定。结果 22例患者最大尿流率2．7～22．1ml／s，平均12．9ml／s；排尿时间17～240s，平均66s；剩余尿5～300ml，平均92ml；最大膀胱容量210～650ml，平均426ml；初次尿意膀胱容量137～540ml，平均296ml；急迫尿意膀胱容量200～620ml，平均388ml。充盈末期膀胱内压均〈50cmH2O，顺应性31～35ml／cmH2O，平均33ml／cmH2O。膀胱容量≤50％时充盈期新膀胱不自主收缩平均1．2次，容量〉50％～100％时2．6次。压力流率测定时患者排尿期新膀胱均未见主动收缩，排尿期最大腹压10～105cmH2O，平均64cmH2O。最大尿道闭合压33～114cmH2O，平均69cmH2O。功能性尿道长度17～56mm，平均37mm。结论 回肠新膀胱具有良好的储尿能力，新膀胱排尿主要依靠腹压和尿道的协同作用，保留尿道的控尿能力是保证术后控尿能力的关键。     

腹腔镜下膀胱全切除、原位回肠新膀胱的尿流动力学分析

目的 探讨腹腔镜膀胱全切除、原位回肠新膀胱的临床效果。方法 对8例行腹腔镜膀胱全切除、原位回肠新膀胱患者进行排尿情况的记录和尿动力学检查。结果 8例患者均可自主控制排尿（1例夜间轻微尿失禁）,在新膀胱充盈过程中均可出现胀痛感觉,膀胱平均容量377．5ml,压力17．9cmH2O,最大尿流率18．1ml／s,最大尿道闭合压68．5cnH2O,功能性尿道长度3．7cm。结论 腹腔镜根治性全膀胱切除、原位回肠新膀胱术较传统的开放手术创伤更小,但贮尿囊一样具有容积较大、内压较低和可控性较好的优点,排尿良好,值得临床推广。     

腹腔镜下全膀胱切除原位回肠新膀胱重建术(附5例报告)

目的:介绍腹腔镜下全膀胱切除原位回肠新膀胱重建术的经验。方法:采用腹腔镜下全膀胱切除原位回肠新膀胱重建术治疗浸润性膀胱癌患者5例。方法是经腹壁小切口取出切除物,行回肠去管成形新膀胱,然后在腹腔镜下将新膀胱与尿道连续吻合。结果:5例患者手术成功,手术时间4.5~7.2h。腹腔镜手术中以超声刀及双极电凝行膀胱侧韧带、前列腺血管蒂及前列腺尖部切断止血,未使用钛夹、术中出血量180~550ml,平均输血400ml。术后4~5天恢复饮食,3周拔除输尿管支架管,4周拔除尿管。患者白天可完全控制排尿,2例夜间偶有尿失禁。1例术后尿漏,经引流治愈。结论:腹腔镜下全膀胱切除术具有创伤小、出血少、恢复快等优点;而回肠新膀胱和尿道连续吻合具有操作方便、省时、缝合紧密、可防止尿漏等优点。     

改良原位螺旋构型回肠新膀胱术32例报告

目的 评价原位螺旋构型回肠新膀胱术的疗效.方法 1998-2008年对32例男性膀胱癌患者行原位螺旋构型回肠新膀胱术.采用40～45 cm回肠新建储尿囊,去管后用无水乙醇擦拭以清除、破坏黏液细胞,螺旋状构型缝合成低压储尿囊.两侧输尿管末端袖口状整形后分别行原位"插入式"置入新膀胱(Split-Cuff术式).新建储尿囊采用"四针法"低位与尿道缝合.结果 本组平均手术时间(281.2±48.7)min;平均失血量(545.4±181.9)ml,术中输血20例,平均输血(430.8±235.9)ml;平均住院时间(26.8±9.7)d.白天控尿良好30例(93.7%),夜间控尿良好26例(81.3%).23例于术后6个月复查尿动力学提示新膀胱初始尿意容量为270～420(315.0±33.4)ml,最大膀胱容量350～600(490.3±39.7)ml,充盈压(22.5±11.8)cm H2O,最大排尿压(78.3±14.7)cm H2O,最大尿流率(16.5±5.9)ml/s.术后随访22～132个月,平均58.4个月,术后2年内死于肿瘤转移4例.结论 原位螺旋形回肠新膀胱具有容量大、相对低压、顺应性好、肠管利用率高、消化道干扰小和术后排尿、控尿功能更接近正常生理等特点.新膀胱经无水乙醇处理后减少了分泌吸收功能,降低了尿路梗阻和代谢紊乱发生率.输尿管新膀胱Split-Cuff乳头"插入式"吻合可有效防止尿液反流,且方法简单,不易引起管口狭窄,有效地保护了肾功能.尿道以"四针法"吻合简单、实用,可减少吻合口狭窄的发生率.改良螺旋构型回肠新膀胱术是一种较为合理的原位膀胱替代方法.

Abstract：

Objective To assess the outcomes of modified spiral ileal orthotopic neobladder.Methods From January 1998 to January 2008, 32 patients (all male) underwent radical cystectomy and spiral ileal orthotopic substitution for muscle invasive bladder cancer. A segment of 40 to 45 cm ileal loop was isolated, detubularized, and reconfigured in spiral shape to form a pouch. Bilateral ureters were reimplanted by inserting the 1 cm distal segment into the pouch to form a Split-Cuff nipple.The bottom of the pouch was opened and anastomosed with the urethra (4 stitches). Results There were no perioperative deaths. The mean operative time was 281.2±48.7 min. Blood loss was 545.4±181.9 ml. Twenty cases required a blood transfusion, the mean volume of intraoprative blood transfusion was 430.8±235.9 ml. The average hospital stays were 26.8±9. 7 days. Rate of daytime continence was 93. 7% (30/32) while nighttime continence was 81.3% (26/32). Urodynamic studies were carried out in 23 cases 6 months after surgery. Neobladder capacity at first desire to urinate was 315.0± 33.4 ml(270-420 ml). The maximum neobladder capacity was 490. 3±39.7 ml(350-600 ml).The maximum flow rate (Qmax) was 16.5 ± 5.9 ml/s. Full resting pressure was 22. 5 ± 11.8 cm H2O. Peak voiding pressure was 78.3 ± 14.7 cm H2O. After mean 58. 4 months' follow up (range 22 to 132), 4 cases died of metastasis of bladder cancer. Conclusion Modified spiral ileal orthotopic neobladder is a reasonable option for treating invasive bladder cancer.     

Laparoscopic orthotopic ileal neobladder

BACKGROUND AND PURPOSE: Orthotopic ileal neobladder is currently the preferred continent urinary diversion in suitable patients undergoing radical cystectomy for muscle-invasive bladder cancer. To our knowledge, presented herein is the initial report of laparoscopic orthotopic ileal neobladder following cystectomy that was performed completely intracorporeally in a porcine model. MATERIALS AND METHODS: The laparoscopic technique was developed in seven pigs. Subsequently, a long-term survival study was performed in 12 consecutive animals. Laparoscopic cystectomy was performed, preserving the urethral sphincter. An ileal segment of 35 cm (first three animals), 45 cm (next four), or 55 cm (final five animals) with adequate mesentery was isolated; and ileal continuity was restored intracorporeally by a stapled anastomosis. Ileal detubularization for construction of an ileal neobladder, urethroileal anastomosis, and bilateral stented ileoureteral anastomoses to a tubular Studer limb extension were all created completely intracorporeally using only laparoscopic free-hand suturing and knot-tying. Biochemical data (preoperative and serial postoperative hemoglobin, renal panel, blood gases), radiologic studies (intravenous urogram, retrograde pouchgram), functional measures (neobladder urodynamics, Whitaker pressure-flow study of both ureters), and microscopic evaluation of the neobladder and ureteroileal and urethroileal anastomotic sites were obtained to evaluate the long-term functional and anatomic outcome. RESULTS: Completely intracorporeal laparoscopic construction of an ileal orthotopic neobladder was successful in all 12 animals without intraoperative or early postoperative complications or open conversion. The mean operating time was 5.4 hours (range 4.5-6.5 hours), and the blood loss was minimal. All study pigs survived their predetermined follow-up period, ranging from 1 to 3 months. Late complications occurred in three animals: one port-site abscess and two cases of E. coli pyelonephritis and azotemia, leading to one death at 2 months. The mean serum creatinine concentrations were 1.33 mg/dL, 1.61 mg/dL, and 1.55 mg/dL at 1, 2, and 3 months, respectively. The mean neobladder capacity was 420 mL (range 250-700 mL) with pressures < or = 20 cm H2O (range 17-20 cm H2O). Pre-euthanasia Whitaker testing confirmed excellent drainage in all 24 ureters. No ileoureteral or ileourethral anastomotic strictures or leaks were noted on intravenous urography, retrograde pouchgram, or postmortem physical calibration of the anastomotic sites. Histologic examination confirmed excellent healing without obvious fibrosis. CONCLUSION: Laparoscopic construction of an orthotopic neobladder is feasible. The anatomic and functional outcome is excellent and comparable to that of open surgery. Clinical application is imminent.     

低张力Roux-y乙状结肠新膀胱在尿流改道中的应用

目的 评价全膀胱切除后低张力抗尿粪逆流Roux-y乙状结肠新膀胱在尿流改道中的疗效.方法 21例患有浸润性膀胱癌的患者施行了膀胱全切、低张力抗尿粪逆流Roux-y乙状结肠新膀胱术,术后随访8～79个月,平均36个月,尿动力学检查包括尿流率、残余尿、膀胱容量和充盈期膀胱压力测定.结果 21例患者最大尿流率21.4～38.4 ml/s,平均28.1 ml/s,排尿时间9～28 8,平均17 s,无残余尿,尿意容量120～410 ml,平均330 ml,膀胱容量350～560 ml,平均480 ml,膀胱充盈期末压力14.2～18.6 cm H2O(1 cm H2O=0.098 kPa),平均16.4 cm H2O,最大排尿压23.6～63.4 cmH2O,平均45.0 cm H2O.结论 低张力Roux-y乙状结肠新膀胱具有良好的储尿功能,是一种有效的可控尿流改道方法.     

经阴道联合腹腔镜下根治性女性全膀胱切除原位回肠新膀胱术

目的 探讨经阴道联合腹腔镜下根治性女性全膀胱切除及原位回肠新膀胱的手术方法.方法浸润性膀胱癌患者6例,平均年龄61(55～73)岁.5孔法先行腹腔镜下手术:游离输尿管后分侧清扫盆腔淋巴结;举宫器配合下,用血管闭合器LigaSure切断子宫相关韧带及膀胱两侧血管蒂;电凝钩分离子宫直肠陷窝及膀胱前间隙;LigaSure切断阴蒂背血管复合体;超声刀切开膀胱颈尿道后游离膀胱颈后壁至阴道前穹窿部.阴道手术:直视下剪开阴道前后穹窿,于阴道取出标本,缝合阴道.回肠新膀胱术:下腹正中4～5 cnl切口,将回肠拉出切口外,游离30～40 cm回肠,剖开后w形折叠缝合形成贮尿囊;插入法植入输尿管后将贮尿囊还纳腹腔.缝合切口后重新开启气腹,腔镜下行新膀胱尿道吻合. 结果 手术时间平均6.2(4～8)h;出血量平均665(400～1200)ml.术后1～3个月患者均恢复较满意的控尿功能,IVU显示双肾功能良好,无膀胱输尿管反流及梗阻.新膀胱最大容量平均427(300～600)ml.无新膀胱阴道瘘等需要手术处理的严重并发症.术后平均随访16(9～30)个月,6例均存活.1例术后8个月发现肝转移. 结论 经阴道联合腹腔镜下根治性女性全膀胱切除回肠新膀胱术治疗女性浸润性膀胱癌可行、有效,应用举宫器及经阴道直视下手术可一定程度上降低腹腔镜下全膀胱切除术的手术难度、缩短手术时间.由于阴道切口整齐、缝合确切,新膀胱阴道瘘等并发症的发生机会减少.     

腹腔镜膀胱癌根治—原位回肠新膀胱术(附5例报告)

目的探讨腹腔镜膀胱癌根治—原位回肠新膀胱术的临床疗效。方法 2008年11月至2011年4月,采用5点穿刺经腹入路,先行腹腔镜下膀胱癌根治,继而体外构建回肠新膀胱,最后腹腔镜下行新膀胱尿道吻合,实施腹腔镜膀胱癌根治—原位回肠新膀胱术5例。皆为男性,平均年龄67岁。结果手术时间420～600min,平均480min,术中失血量350～800ml,平均400ml。术后淋巴结及手术切缘均阴性。随访3～24个月,除1例有轻度夜间尿失禁外,其余患者均昼夜控尿良好。代膀胱充盈良好,容量200～350ml,平均270ml。平均最大尿流率12ml/s。1例出现勃起功能障碍。结论腹腔镜膀胱癌根治—原位回肠新膀胱术创伤小、出血少、并发症少且疗效满意。     

球形可控回肠膀胱术的尿动力学研究

目的 探讨球形可控回肠原位膀胱术的尿动力学特点和临床效果.方法 1999年1月至2008年6月行球形可控回肠原位新膀胱术48例,对其中26例男性患者(膀胱移行细胞癌20例,移行细胞癌部分鳞化4例,移行细胞癌伴腺癌及鳞癌1例,移行细胞癌伴隐匿前列腺腺癌1例)进行尿动力学随访.统计学比较患者术后3～12个月新膀胱压力、容积、尿道压和尿流率等指标.结果 术后6个月26例患者新膀胱容量400 ml时基本压力＜15 cm H2O(1 cm H2O=0.098 kPa),膀胱完全充盈时平均压力为18.2 cm H2O.新膀胱平均收缩压＜40 cm H2O.术后膀胱充盈期压力比较:3个月与6个月t=3.03,P＜0.05;6个月与9个月t=0.54,P＞0.05;9个月与12个月t=1.27,P＞0.05;平均残余尿42 ml.Valsalva动作排尿,排尿峰值平均19.6 ml/s.术后平均4.5个月患者昼夜控尿率分别为92%(24/26)和65%(17/26).结果 球形可控回肠膀胱术所需肠管短、容量大、压力低、可控性好,是原位膀胱重建的良好术式.     

Laparoscopic radical cystectomy with orthotopic neobladder

PURPOSE: We report our technique of laparoscopic radical cystectomy in nine patients. Diversion was achieved by a modified Camey II orthotopic neobladder (the Y bladder) performed by a minilaparotomy in three cases and laparoscopically in the last six cases. PATIENTS AND METHODS: There were eight men with muscle-invasive transitional-cell carcinoma and one woman with verrucous squamous-cell carcinoma of the bladder. The age range was 41 to 65 years. The control of the posterior and lateral bladder pedicles was achieved by vascular Endo-GIA in the first three cases and by the 10-mm Harmonic Shears (Ultracision; Ethicon) in the last six cases. The operative specimen was extracted through a 3- to 5-cm muscle-splitting incision in the right iliac fossa. The detubularized pouch was prepared extracorporeally through the same incision. The urethral and ureteral anastomoses were performed using laparoscopic intracorporeal suturing in the last six cases. RESULTS: The operative time ranged from 6.5 to 12 hours (median 8.3 hours). The blood loss was 150 to 500 mL. Oral feeding was resumed on the 3rd postoperative day. The stents were usually removed on the 8th postoperative day. A pouchogram was obtained on the 10th postoperative day, and the urethral catheter was removed. The lymph nodes as well as the surgical margins were tumor free. CONCLUSION: Laparoscopic radical cystectomy and orthotopic neobladder creation is feasible, although difficult and technically demanding. The use of the Harmonic Shears in the cystectomy reduces the operative cost significantly. With growing experience, laparoscopic radical cystectomy and continent urinary diversion can be an alternative to the open technique.     

Experience with the orthotopic ileal neobladder in women: a mid-term follow-up

OBJECTIVE: To report our experience with orthotopic bladder reconstruction in women, as currently the ileal orthotopic neobladder is the diversion of choice for women requiring a bladder substitute at our institution. PATIENTS AND METHODS: From February 1995 to March 2001, 29 women with muscle-invasive bladder carcinoma underwent a nerve-sparing radical cystectomy and had an orthotopic ileal neobladder reconstructed. The outcome was evaluated at 2 and 6 months and then yearly, by a clinical history, physical examination, voiding diary, stress test and estimate of functional neobladder capacity. RESULTS: All patients were followed for at least 14 months (mean 27.5); there were no major complications related to the surgery. The mean (range) neobladder capacity 2 months after surgery was 250 (190-320) mL; at 6 months it increased, remaining stable for the remaining follow-up, at 450 (350-700) mL. Four patients (14%) had nocturnal incontinence and one stress urinary incontinence, associated with using three pads per day. Three patients (10%) required catheterization for a postvoid urinary residual of >100 mL. Of the 29 patients, seven died with metastatic disease and three from causes unrelated to the reservoir or bladder cancer. Currently, 19 patients (65%) are alive and disease-free, with a mean follow-up of 35 months. CONCLUSION: Orthotopic neobladder reconstruction in women, using 40 cm of ileum, is safe and gives high continence and low urinary retention rates. Therefore, it should be advised as the first option in women with good renal function and a tumour-free bladder neck.