A Novel Antireflux Technique for Orthotopic Ileal Bladder Substitutes—Flat-Segment Technique : Preliminary Results

Abstract EN

Objective.

Although a large debate exists regarding the need for reflux prevention in ileal orthotopic neobladders, it is our policy to continue performing nonrefluxing ureteroileal anastomoses for our patients.

An ideal uretero-ileal anastomosis must be simple, nonrefluxing, as well as non-obstructive.

Here, we present a new antireflux mechanism for orthotopic ileal neobladders.

Methods.

12 radical cystectomy patients for muscle invasive bladder cancer were candidates for orthotopic urinary diversion and underwent a non-refluxing uretero-ileal anastomosis using the flat-segment technique with a follow up of 6 to 18 months.

Results.

Preliminary results after the short-term followup showed that the success rate in reflux prevention was 92% and no cases of obstruction.

The upper tracts were preserved or improved in all 12 patients.

Operative time for neobladder creation ranged between 120–240 minutes, with a mean of 165 minutes (±36 minutes).

No diversion-related complications.

Conclusions.

Based on our early data, we believe that the flat-segment uretero-ileal anastomosis technique for reflux prevention in orthotopic ileal bladder substitutes is simple, easy to learn and carries no additional morbidity to a standard refluxing uretero-ileal anastomosis, but has the advantage of effective reflux prevention.

A longer follow-up period study with more patient numbers is ongoing.