V08-08 the Difficult Neobladder: Techniques to Mobilize the Ileum to the Urethra

You have accessJournal of UrologyBladder & Urothelial Upper Tract Oncology (V08)1 May 2024V08-08 THE DIFFICULT NEOBLADDER: TECHNIQUES TO MOBILIZE THE ILEUM TO THE URETHRA Neeraja Tillu, Etienne Lavallee, Reuben Ben-David, Prachee Pathak, John Sfakianos, Reza Mehrazin, and Peter Wiklund Neeraja TilluNeeraja Tillu , Etienne LavalleeEtienne Lavallee , Reuben Ben-DavidReuben Ben-David , Prachee PathakPrachee Pathak , John SfakianosJohn Sfakianos , Reza MehrazinReza Mehrazin , and Peter WiklundPeter Wiklund View All Author Informationhttps://doi.org/10.1097/01.JU.0001009440.59296.9f.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Karolinska modification of the Struder neobladder involves the urethroileal anastomosis as the first step. A short mesentery or a scarred mesentery (due to previous radiation/surgery) may abort the procedure and cause a conversion to an ileal conduit. We describe the sequential techniques needed to bring the ileum down to the urethra in such situations. METHODS: After the robotic cystectomy the apex of the ileal segment, 35-40cm from the ileocecal junction, is brought down to the urethra. If the bowel segment does not reach the urethra without tension, the following techniques can be used.Technique number 1: Lysis of any adhesions between the bowel and other bowel loops or the peritoneum. Along with this scoring of the mesentery can be done, taking care to not injure the mesenteric vessels.Technique number 2: Passing a foley catheter through the urethra to bring the ileal loops down with a stitch.Technique number 3: A modified Rocco's stitch is done between the rhabdosphincter of the urethra and the Denonvillier's fascia to construct the posterior plate. Technique number 4: Passage of two vessel loops through the mesentery on either side of the ileal segment to be brought down to the urethra. The rest of the neobladder is created per the usual technique.At the end of the procedure, a leak test is performed. RESULTS: We performed the technique in 6 patients from December 2022 to October 2023. The mean operative time was 320(46 SD)minutes. The mean length of stay was 6.2(2.8 SD) days. The catheter was kept for 4 weeks in all patients. 4/6 patients (66.7%) patients were continent (used a safety pad) during the day after 3 months. 3/6 (50%) achieved night-time continence by 6 months. CONCLUSIONS: Difficulty in bringing the ileum down can be overcome by certain techniques in the Struder neobladder. This prevents conversion to a ileal conduit and maintains the desired outcome. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e559 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Neeraja Tillu More articles by this author Etienne Lavallee More articles by this author Reuben Ben-David More articles by this author Prachee Pathak More articles by this author John Sfakianos More articles by this author Reza Mehrazin More articles by this author Peter Wiklund More articles by this author Expand All Advertisement PDF downloadLoading ...