Modified Technique for the Creation of an Orthotopic Neobladder in Patients With Shortened Mesentery: Making Up the Difference Between the Bladder and the Urethral Stump

Objective To describe an ileal neobladder reconstruction technique performed in 5 men who had previous abdominal surgeries and presented with a short mesoileum at the time of bladder replacement. Methods The patients were 5 men scheduled for a radical cystoprostatectomy with bladder substitution and had a short mesoileum at the time of the surgery. All patients had a history of abdominal surgery. A neobladder was constructed in a “J” shape leaving the most proximal part of the ileum (8-10 cm) tubularized. We created a 3- to 4-cm flap from the surface of the most distal region of the reservoir. This flap was tubularized to lengthen the neobladder onto the urethral stump, resulting in a tension-free anastomosis. All patients underwent a complete clinical laboratory evaluation 12 months after the surgery. Results At 1 year after surgery, all patients were able to void spontaneously. Day and night time continence were 80% and 60%, respectively. Urodynamic evaluation revealed a neobladder with good capacity (mean = 521 ml) and compliance (mean = 27.2 mL/cm H2O). Only 1 patient demonstrated a moderate hydronephrosis of the right kidney. Conclusion Candidates for orthotopic neobladders who have had previous abdominal surgeries and who have a short mesoileum at the time of the surgery are uncommon. Despite the small number of cases, our technique is noteworthy for having achieved good functional results during the short-term follow-up. This technique is advantageous because it is easy to perform and does not require any other bowel resection or anastomose. To describe an ileal neobladder reconstruction technique performed in 5 men who had previous abdominal surgeries and presented with a short mesoileum at the time of bladder replacement. The patients were 5 men scheduled for a radical cystoprostatectomy with bladder substitution and had a short mesoileum at the time of the surgery. All patients had a history of abdominal surgery. A neobladder was constructed in a “J” shape leaving the most proximal part of the ileum (8-10 cm) tubularized. We created a 3- to 4-cm flap from the surface of the most distal region of the reservoir. This flap was tubularized to lengthen the neobladder onto the urethral stump, resulting in a tension-free anastomosis. All patients underwent a complete clinical laboratory evaluation 12 months after the surgery. At 1 year after surgery, all patients were able to void spontaneously. Day and night time continence were 80% and 60%, respectively. Urodynamic evaluation revealed a neobladder with good capacity (mean = 521 ml) and compliance (mean = 27.2 mL/cm H2O). Only 1 patient demonstrated a moderate hydronephrosis of the right kidney. Candidates for orthotopic neobladders who have had previous abdominal surgeries and who have a short mesoileum at the time of the surgery are uncommon. Despite the small number of cases, our technique is noteworthy for having achieved good functional results during the short-term follow-up. This technique is advantageous because it is easy to perform and does not require any other bowel resection or anastomose.