Further clinical experience with the ileal W‐neobladder and a serous‐lined extramural tunnel for orthotopic substitution

OBJECTIVE: To report on the functional results following orthotopic substitution using an ileal W-neobladder with an extramural serous-lined tunnel for reflux prevention. PATIENTS AND METHODS: Sixty men (mean age 46 years) underwent a one-stage radical cystoprostatectomy and an ileal W-neobladder for invasive bladder cancer. The technique entails the creation of two serous-lined extramural tunnels in a detubularized ileal W-bladder fashioned from 40 cm of the terminal ileum. Fifty-one patients were evaluable, with a minimum follow-up of 2 years. Evaluation of patients included clinical, radiographic and urodynamic studies. RESULTS: There was no operative mortality and no gross morbidity. The upper tracts remain unchanged or improved in 97% of the implanted renal units. Reflux was not observed in any patient. The incidence of day and night continence was 90 and 80%, respectively. CONCLUSION: The technique provides a non-obstructed unidirectional uretero-ileal re-implantation, in a low-pressure system constructed from a short ileal segment. No staples were required.