Five years experience with the modified ileal neobladder

Abstract

We used the technique of modified Heal neobladder for orthotopic bladder replacement using an Heal pouch after radical cystoprostatectomy in 150 selected patients. All were males with an age range of 32-68 years (mean ±52.5 yr.). The procedure was carried out using 35-50 cm of ileum with double folding of the fashioned detubularized segment. The created pouch had an average capacity of 450- 700 ml. (mean ± 500 ml) and a pressure of 5-30 cm H2O (mean ± 14 ml) . The ureters were anastomosed according to the technique of Le Duc and Camey in 47 cases while in 103 cases they were directly implanted. After a follow up period of 8-60 months (mean ± 36 months), our results were satisfactory regarding continence, preservation of kidney function and patients'quality of life.. Total continence was achieved in 132 cases (88%). Day time continence could be achieved in 145 (96%) patients, and bed wetting was reported by 13 patients (9 %). Urethral strictures was reported in 4 patients (2.6%). Our study entailed performing 292 Uretero-ileal anastomosis. Uretero-ileal anastomotic stricture complicated 6 procedures(2%) in 4 patients (2.6 %). Reflux was noticed in 28 (9.5%) implanted ureters. This accounted for 20% of the directly implanted ureters and 4% of those underwent antireflux ureteroileal anastomosis.. Renal function deterioration occurred in 9 patients (6%). This was secondary to Uretero-ileal anastomotic stricture in 2 cases, to reflux in 2 patients and to pouch decompensation in 5 patients. Gradual pouch distention with neohladder decompensation occurred in 23 patients (15%). In our later cases we advocated the use of a shorter Heal segment (35- 40 cm), instructed our patients to void on a regular 4 houriv basis and recommend the use of clean intermittent catheterization at least once daily. This protocol decreased the incidence of pouch decompensation from 23% % in our early series to 7% in the tatter. Our modifed Heal neobladder is close to being an ideal bladder substitute specially in terms of continence and minimal long term complications. The low pressure character of the Heal bladder minimizes the incidence of reflux which if occurred will be of minimal effect on renal function. The relatively high incidence of pouch decompensation could be minimized by using shorter Heal seoments and regular pouch evacuation.