Inversion of orthotopic ileal neobladder to prevent tension in anastomosis

Orthotopic ileal neobladder is the standard alternative after cystectomy, ensuring the recovery of selfurination, a full social and psychological rehabilitation of patients. From 1993 to 2010 cystectomy were performed to 209 patients, 119 (57,0%) of which underwent orthotopic bladder reconstruction in various forms: colonic plastics – 48 (40,3%) patients, intestinal plastics – 71 (59,7%) patients. In cases when short mesentery occured, a special method for bladder reconstruction was developed. The method consists in the longitudinal, not transversal crosslinking of the tank, as in the Studer orthotopic ileal neobladder, and inverting its positioning in the pelvis maximally closer to the tank wall, and overlapping tensionfree urethroreservoir anastomosis. We operated on 21 patients using this method of bladder reconstruction. All cases with insufficient length of the mesentery were compensated by the offset technique of inverting of orthotopic ileal neobladder. Cases of leak of the tank or anastomosis were not observed. Medium capacity of neobladder after removal of urethral catheter – 110 ml., in 3 months – 350 ml, in 12 months – 490.0 ml. Maximum pressure in the tank does not exceed 40 cm water column (average 30 cm H 2O). Day retention – 94,7%, night confinement at a forced night miction – 79.0%. The proposed method of inverting orthotopic ileal neobladder can be recommended when overlapping of orthotopic urinary reservoir is impossible or associated with leaks of the anastomosis due to the insufficient length of the mesentery using known techniques of orthotopic ileal bladder reconstruction.