Y neobladder an easy, fast and reliable technique (SIU 2011)
- uploaded: Jul 22, 2011
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Institution:Ospedale â€œSan Giovanni Battista â€“ Molinetteâ€, Torino, Italy
Introduction & objectives
During the past 20 years, greater attention to the quality of life has prompted wider use of orthotopic neobladders in patients undergoing radical cystectomy for bladder cancer. Nevertheless, despite improved surgical techniques, some problems concerning neobladders have not yet been solved, in particular, strictures of the ureteral anastomosis. In the last 90's, we proposed a new kind of ileal ortothopic reservoir: the Y-neobladder proved to be easy and fast to create, to provide good functional results and to have a very low incidence of strictures of ureteral-neobladder anastomosis.
Material & Methods
The reservoir is created by isolating 40 cm of ileum. The isolated ileal segment is made of two central parts of 14 cm and two limbs of 6 cm. The two central segments are arranged together in a Y shape. An opening is made at the lowest point of the neobladder. The two central segments are brought together and detubularized with a titanium mechanical stapler. The Y-neobladder is anastomosed to the urethra with five sutures in 2-0 polyglycolic acid. The ureters are spatulated anteriorly and are anastomosed to the dorsal aspect of the two limbs with 5-0 polyglycolic acid sutures, using the direct Nesbit technique. The limbs are fixed with a single suture to the psoas muscles in order to fasten the anastomoses.
The operative time for the orthotopic neobladder creation is 15 to 20 minutes; the mean overall time required is 90 minutes. The functional outcomes overlap with those of the most popular techniques. Regarding complications we have recorded strictures of the ureteral anastomosis only in 0,56% of renal units; 8% of patients developed a stricture of the urethral anastomosis, and 6,5% neobladder stones.
The major advantages of this technique are: the easy and fast procedure, the low occurrence of strictures of ureteral anastomosis and the easy endoscopic examination of the upper urinary tract, permitted by the alignment of the ureter with the ileal limb. The rate of ureteral anastomotic strictures is very low because it is not necessary to mobilize the ureter, which remains in its natural position, with its own vessels.
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