Bladder replacement by ileocystoplasty following radical cystectomy

Summary

Between 1958 and 1985, over 402 patients underwent a radical cystoprostatectomy for bladder cancer. In 150, the bladder was replaced by a U-shape segment of ileum anastomosed midway to the urethral stump; the ureters were anastomosed to each end of the loop via an antireflux technique. Continence was achieved by an external sphincter mechanism and voiding accomplished by voluntary sphincter relaxation and abdominal straining. In the past 10 years, daytime continence has been achieved in 95% of cases. Nighttime continence was obtained in 50% by means of rehabilitation. Antireflux implantation, checked by retrograde cystogram, was proven effective in 85% of cases. The residual volume is generally moderate and 70% of patients maintain sterile urine, which is an essential factor in protecting renal function. This procedure can be performed only in patients at low risk of urethral recurrence. They must be able to undergo major surgery and be well informed and motivated. The surgical team must adhere to the rules of this long and difficult procedure.