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Orthotopic sigmoid neobladder in women - preliminary report
Article published in Urologia Polska 2004/57/4.

authors

Andrzej Koziak, Ryszard Szcześniewski, Tadeusz Dmowski, Adam Dorobek, Adam Marcheluk, Piotr Kania
Oddział Urologii Wojewódzkiego Szpitala Specjalistycznego w Siedlcach
Ordynator oddziału: dr n. med. Andrzej Koziak

keywords

urinary bladder, bladder cancer, sigmoid neobladder

summary

introduction and objectives
There are many surgical techniques of bladder reconstruction in women using ileum or ileocecal segment. We present our own method of cystoplasty by using sigmoid colonic loop for bladder reconstruction, which we routinely use in men with excellent result. We present our first surgical experience with orthotopic sigmoid bladder replacement in women. In our knowledge it is one of the first reports about sigmoid neobladder reconstruction in women.
materials and methods
We made the sigmoid neobladder reconstruction in 5 selected women with invasive bladder carcinoma (pT 2b - pT 3b). After radical cystectomy a sigmoid colonic segment as long as 25-30 cm was isolated. We cut isolated loop along antimesenteric tenia leaving untouched distal 3 cm long part - a future new neck of the neo-bladder. Having such prepared sigmoid loop we cut tunica mucosa about 0,5 cm from distal end going to muscular cut. We put chain suture on muscular cut - new inter-nal urethral sphincter. Next steps of the operation were: implantation of ureters using antireflux technique, connection of new bladder neck to stump of the urethra, suturing and forming the new bladder. The blood chemistry, continence and voiding pattern were analysed during follow-up.
results
Urodynamic study and intravenous pyelography showed that neobladder had proper volume and all the patients achieved excellent continence. There were no metabolic and nutritional complications.
conclusions
The sigmoid neobladder is alternative method of treatment of bladder malignancy. An orthotopic sigmoid neobladder can be constructed in women with excellent functional results. In order to confirm the presented observation it is necessary to carry out studies, which would include a larger number of operated patients.

references

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correspondence

Andrzej Koziak
Wojewódzki Szpital Specjalistyczny
Oddział Urologii
ul. Poniatowskiego 26
08-110 Siedlce
tel. (0 25) 640 35 12, fax 640 32 98