V06-05: Application of a modified orthotopic neobladder after radical cystectomy in 16 patients
Radical cystectomy with lymph node dissection and urinary diversion is the gold-standard treatment for muscle-invasive bladder cancer. Due to the demand for a perfect body image and good quality of life, the orthotopic ileal neobladder became popular gradually. In 1989, Studer successfully constructed a spherical reservoir as a neobladder with four cross-folded opened ileal segments. The construction of neobladder is challenging and complicated. To simplify the surgical procedures of constructing a pouch, we designed the IUPU neobladder.
From July 2017, the technique has been performed in 16 patients and the cases were reviewed. For constructing the reservoir, an ileal segment of about 54 cm long is isolated, 25 cm proximal to the ileocaecal valve. The ileum segment is measured and marked in portions of 12cm, 12cm, 15cm, and 15 cm along the border of the mesoileum without stretching the bowel. Of the segment, 39 cm is for the spherical pouch and 15 cm for the afferent limb. After well cleaned and rinsed, the distal 39 cm of the ileal segment is opened along its antimesenteric border. The segment was incised at a ratio of 1 to 2 at the beginning and 1 to 1 at the end, in which there was a gradual transition. The distal 12 cm ileal segment was folded and the neighboring edges of the two 12 cm ileal segments were joined by continuously suturing twice. Next, the other edge of the distal 12 cm ileal segment was folded, and apposed to the adjacent edge of the 15 cm opened ileal segment. Then the neighboring edges of the two 15 cm opened ileal segments were aligned naturally and joined. A small opening was left at the most caudal part of the reservoir for further anastomose with the urethra. After insertion of single-J stents into each of the two ureters, the two ureters were anastomosed into one 2.5-centimeter-long combined ureter, for the end-to-end anastomosis with the ileal segment. Then cystostomy and neobladder-urethral anastomosis were performed.
The average time of the bladder suturing is 23.38 mins. And there is no serious postoperative complication.
The IUPU neobladder is easy and safe. The technique should be an alternative for patients after radical cystectomy.