Spiral ileal neobladder substitution with orthotopic ureteral reimplantation: early results.

PURPOSE: The aim of this report is to present our experience with the spiral ileal neobladder. MATERIALS AND METHODS: From September 1996 to August 1999, 39 patients (35 men and 4 women) underwent radical cystectomy and spiral ileal orthotopic substitution for muscle invasive bladder cancer. Seventy ureters in 37 patients were reimplanted orthotopically using the nonrefluxing Ghoneim technique. Evaluation of these patients included video urodynamics, intravenous pyelogram, renal ultrasound, and patient history relating to urinary incontinence. RESULTS: There were no perioperative deaths. There were 8 (20.5%) early complications. One patient developed a small bowel anastomotic leak, and another patient presented with a vesicovaginal fistula repaired transabdominally. Of the 70 ureters reimplanted in Ghoneim fashion, 5 (7.1%) developed an anastomotic stricture. Three of these patients had stable hydronephrosis and were managed by observation alone; one stricture was treated successfully transurethrally with balloon dilation; and the last patient was managed with a percutaneous nephrostomy tube and surgical reimplantation. Urodynamics in eight patients revealed a Valsalva leak point pressure >50 in two patients and >100 in the six patients. All women experienced mild daytime and nighttime urinary incontinence. Ninety percent of the men were either dry or complained of mild daytime incontinence. No patient experienced bowel dysfunction from the ileal resection. CONCLUSIONS: The spiral ileal neobladder offers the potential advantages of construction from a relatively short bowel segment, excellent length for ureteral anastomosis, acceptable continence rates, and orthotopically reimplanted ureters, which allow transurethral upper tract access. The nonrefluxing ureteral anastomosis has a high stricture rate, and we currently are reimplanting the ureters orthopically in a nontunneled fashion.