Bladder replacement by detubularized ileal loop:

Objective  To evaluate the results obtained with a technique of bladder replacement using a detubularized ileal tract, developed by the authors. Patients and methods  Since 1983, 34 patients have undergone an orthotopic bladder replacement using 35–40 cm of ileum, detubularized and shaped into an ‘S’ to create a neobladder with a capacity of 100–120 mL. The ureters were anastomosed directly to a 10 cm long intact afferent loop which serves as an anti‐reflux mechanism, while a 2 cm long efferent, spatulated loop was used for urethral anastomosis. The mean (sd) follow‐up was 32 (33) months. Results  All the patients were continent during the day, with socially convenient intervals between voids; 3 years after the operation, 10 of 12 patients were continent during the night, with intervals of 2–4 h between voids. The mean post‐void residual urine volume was 41 mL and no patient required self‐catheterization. There were no derangements of the metabolic status of patients. Conclusion  This technique was applied knowing that a detubularized intestinal loop has the remarkable ability to increase in capacity over time. Therefore, to maintain the reservoir in good condition over a long period it is important to construct it with an intra‐operative capacity of <120 mL, thus reducing the length of intestine required. This may explain the satisfactory metabolic status of these patients. Moreover, the triplication of the mesentery helps to maintain the sphericity of the neobladder and provides support for the neobladder in the lower pelvis, where it retains the same position as a normal bladder.