The Ileal W-neobladder: Early Experience in 13 Patients

Kim, Sae Woong; Oh, Jang Min; Lee, Ji Youl; Cho, Yong Hyun; Yoon, Moon Soo

Abstract

PURPOSE: We performed an ileal W-neobladder for total bladder replacement and evaluated this procedure in comparison with previously performed bladder substitution. MATERIALS AND METHODS: Total 21 patients underwent this procedure between September 1996 and December 1997. About 40cm long segment of the distal ileum was isolated and arranged in W-shaped configuration. A spherical pouch, the neobladder, with the ureters are implanted at each serous-lined intestinal trough was fashioned and was anastomosed to the urethra. RESULTS: The mean operation time was 452 minutes. 4 patients were missed on follow-up. Among the 17 remaining patients, there was no perioperative mortality or serious immediate complication but mild ileus, atelectasis or wound disruption. Reoperation was necessary in only 1 case due to wound dehescence. The late complication was 1 case of ureterointestinal stricture which was managed with balloon dilatation and 9/17 cases of nocturnal incontinence at 2 months after operation, which was improved as times goes by. We could follow up more than 6 months in 8 patients and they were all continent at night. Urinary reflux was not observed at 14th postoperative day on cystography. All 17 patients had recognizable sensation of bladder distension closely simulating those of normal bladders. The urodynamic study revealed a capacity approximating that of a normal bladder and showed good compliance during filling by maintaining low pressure. CONCLUSIONS: According to our initial experience, the use of ileal W-neobladder in men after radical cystectomy offers free of a stoma to urinary diversion, resulting in a highly compliant, low pressure, and acceptable residual urine without serious complication.