ILEAL NEOBLADDER AND ITS VARIANTS
Authors:
G. Gakis; A. Stenzl
Authors‘ workplace:
Department of Urology Eberhard-Karls University Tuebingen
Published in:
Urol List 2011; 9(3): 27-33
Overview
Orthotopic neobladder substitution represents an important step in the evolution of urinary diversion and is nowadays considered, both in males and females, as the diversion of choice for the majority of patients undergoing cystectomy with which other types of diversion have to compare. Nevertheless, in the preoperative setting, all options of urinary diversion should be explained comprehensibly to the patient as well as potential short- and long-term risks along with beneficial effects of each type of diversion. With regard to the risk of urethral recurrence the decision to perform a neobladder depends ultimately on the intraoperative frozen section analysis of the distal urethral margin. Neobladder construction is based on the concept of detubularisation and folding to construct a low-pressure reservoir. All parts of the small and large intestine as well as the stomach have been intensely studied for the construction of neobladders. In this respect, there is substantial agreement in the literature that the terminal ileum possess superior anatomical and functional characteristics. In light of the lack of prospective randomised trials controversies still exist with regard to the technique of preventing reflux in orthotopic substitutes and superiority of one neobladder technique over others provided the detubularized intestinal segment is reconfigurated to an adequate-sized spherical reservoir. Based on current evidence, orthotopic neobladder substitution is nowadays considered, both in male and female patients, as the diversion of choice for the majority of patients undergoing cystectomy with which other types of diversion have to compare.
Key words:
antireflux, diversion, ileum, low-pressure reservoir, orthotopic neobladder
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Paediatric urologist UrologyArticle was published in
Urological Journal
2011 Issue 3
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