Advantages of the ileal over the ileocecal orthotopic neobladder in patients with invasive bladder cancer

Abstract AR

Introduction and Objectives: Different segments of small and large bowel have been used in the construction of the orthotopic neobladder in patients undergoing cystectomy for invasive bladder cancer.

Ileocecal and ileal neobladders performed in a single institution are compared.

Materials and Methods: In 29 patients, ileocecal neobladder was constructed while 23 patients had ileal neobladder.

In the ileocecal group, the cecum and the ascending colon are mobilized, appendectomy is performed, the ileocecal valve is opened, the ureters are implanted in the taenia, and a cecostomy tube is placed.

In the ileal group, the ureters are subserosally implanted and no suprapubic tube is exteriorized.

Results: There was no operative mortality in either group.

Three patients needed intermittent catheterization.

Both groups tolerated adjuvant chemotherapy and radiation therapy.

Three patients from the ileocecal group devel¬oped uretero-intestinal strictures versus one from the ileal group.

Mucus production was significantly higher in the ileocecal group.

Operating time was longer for the ileocecal group.

Conclusions: Both ileal and ileocecal neobladder are excellent urinary substitutes, and they are functionally comparable.

The ileal neobladder offers the following advantages: (1) Mobilization of the cecum and ascending colon and appendectomy are not required which leads to a shorter operating time.

(2) Intact ileocecal valve.

(3) Fewer uretero-intestinal strictures.

(4) Less mucus production meaning that there is no need for a suprapubic tube.