Modified orthotopic ileal neobladder - surgical technique and initial results

Introduction/Objective Vesica ileale Padovana is the surgical technique for reconstruction of lower urinary tract following radical cystectomy using isolated ileal segment.This operative technique requires dissection of both ureters in full length that cannot be possible in some cases. The paper is aimed to present our experience with modified surgical technique of vesica ileale Padovana using 40 cm of an isolated ileal segment. Methods Ten male patients received modified ileal neobladder following radical cystectomy at our institution during the period from 2008 to 2011. The mean age of patients was 59 years (range 45-70). Median follow-up was 76 months (range 62-93). Patients were monitored cautiously for functional outcome, local recurrence, and distant progression. Results Perioperative, early, and late postoperative mortality have not been noticed.There were only two major complications: prolonged postoperative ileus and prolonged urinary leakage requiring percutaneous nephrostomy and subsequent ureteral reimplantation due to stenosis of ureterovesical anastomosis in one patient (10%). Average ileal neobladder capacity was 450 ml. Daytime and night continence were achieved in nine (90%) and seven (70%) patients, respectively. Conclusion This modification of orthotopic ileal neobladder has not been difficult to perform in our hands. Modified technique provides a clear advantage in easier ureteral implantation more proximally than in the original technique, requiring less length of ureters. Initial encouraging results should be confirmed in further clinical practice.