The S-shaped orthotopic ileal neobladder substitute incorporating a new seromuscular antireflux technique (split ileal end) in a series of 50 patients.

OBJECTIVE: The purpose of this study was to assess the function of our new technique, complications, continence, voiding patterns in those patients with the clinical evaluation of the S-shaped orthotopic ileal neobladder substitute incorporating a new antireflux technique.

PATIENTS AND METHODS: Between April 2002 and November 2006, 50 patients (44 men and 6 women) underwent radical cystectomy and S-shaped ileal neobladder reconstruction with our new antireflux technique (split seromuscular). The mean age of male patients was 58 years (45-71 years). The mean age of female patients was 50 years (45-55 years). In all patients an S-shaped ileal pouch was constructed incorporating the new antireflux technique. This antireflux has not yet been described in the literature before. All procedures are performed by the same surgeons and the mean follow-up was 30 months. Complications were registered as early (occurring within 3 months) or late (occurring after 3 months), and as diversion-related and diversion-unrelated. Continence and voiding patterns were also evaluated.

RESULTS: There is no reflux in all patients except one. Early complications occurred in 8 patients. The most common early diversion-related complication was urinary leakage in 3 patients. No patients sustained an early diversion-related complication attributed to the new antireflux technique. Late complications occurred in 6 patients. Overall, 39 patients voided to completion without needing catheterization. A total of 7 patients required some form of clean intermittent catheterization to empty the new bladder completely including 5 of 44 men (12.5%) and 2 of 6 women (33.3%).

CONCLUSIONS: The functional results with this pouch incorporating the new antireflux technique were efficient. Our S-shaped pouch has reduced the length of intestine (37 cm) that minimized the metabolic and malabsorption complications. Moreover it is simple.