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


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


urinary bladder, bladder cancer, sigmoid neobladder


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.
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.
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.


  1. Stein JP, Stenzl A, Esrig D et al: Lower urinary tract reconstruction following cystectomy in women using the Kock ileal reservoir with bilateral ureteroileal urethrostomy: initial clinical experience. J Urol 1994; 152: 1404-1408.
  2. Tobisu K, Coloby PJ, Fujimoto H, et al: An ileal neobladder for a female patient after a radical cystectomy to en-sure voiding from the urethra: a case report. Jpn J Clin Oncol 1992; 22: 359-364.
  3. Stenzl A, Colleselli K, Poisel S: Rationale and technique of nerve-sparing radical cystectomy before an orthotopic neobladder procedure in women. J Urol 1995; 154: 2044-2049.
  4. Stein JP, Cote RJ, Freeman JA: Indication for lower urinary tract reconstruction in women after cystectomy for bladder cancer: a pathological review of female cystectomy specimens. J Urol 1995; 154: 1329-1333.
  5. Hautmann RE, Paiss T, and de Petriconi R: The ileal neobladder in women: 9 years of experience with 18 patients. J Urol 1996; 155: 76-81.
  6. Stein JP, Stenzl A, Grossfeld GD et al: The use of orthotopic neobladder in women undergoing cystectomy for pelvic malignancy. World J Urol 1996; 14: 9-14.
  7. Wolski Z: Zastępczy pęcherz jelitowy u kobiet po radykalnej cystektomii. Urol Pol 1997; 4: 419.
  8. Stenzl A, Colleselli K, and Bartsch G: Update of urethral sparing approaches in cystectomy in women. World J Urol 1997; 15: 134- 138.
  9. Fryczkowski M: Zastępczy pęcherz jelitowy u 2 kobiet z rakiem pęcherza moczowego. 5-letnie obserwacje. Urol Pol 1997; 4: 477.
  10. Lorenz J: Zastępczy pęcherz jelitowy u kobiety. Siedmioletnie obserwacje. Urol Pol 1997; 4: 481.
  11. Racioppi M, Addessi A, Fanasca et al: Acid-base and electrolyte balance in urinaryintestinal orthotopic reservoir: ileocecal neobladder compared with ileal neobladder. Urology 1999; 54: 629-635.
  12. Fujisawa M, Gotoh A, Miyazaki S et al: Sigmoid neoblader in women after radical cystectomy. J Urol 2000; 163: 1505-1509.
  13. Reddy PK: The colonic bladder. Urol Clin North Am 1991; 18: 609- 614.
  14. Koziak A, Szcześniewski R, Komoń H, Olszewski J: Radykalna cystoprostatektomia przedotrzewnowa z wytworzeniem pęcherza esiczego w modyfikacji własnej. Urol Pol 1999; 52a: 67.
  15. Fujisawa M, Isotani S, Gotoh et al: Voiding Dysfunction of sigmoid neobladder in women: a comperative study with men. Eur Urol 2001; 40: 191-195.
  16. Fujisawa M, Takenaka A, Kamidono S: A new technique for creation of a sigmoid neobladder for urinary reconstruction: clinical outcome in 42 men. Urology 2003; 62: 254-258.
  17. Fujisawa M, Gotoh A, Nakamura I et al: Long-term assessment of serum vitamin B12 concentrations in patients with various types of orthotopic intestinal neobladder. Urology 2000; 56: 236-240.


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