Derivazione ortotopica continente tipo emiKock: Nostra esperienza

Abstract

Between May 1991 and October 1993, 16 male patients with bladder neoplasms underwent surgical hemiKock's technique of continent urinary reservoir: 7 patients were staged T1, 4 patients were T2, 3 patients were T3 and 2 patients were T4. 5 patients underwent neo-adjuvant M-VAC chemotherapy before surgery, 2 patients underwent radiotherapy and 2 patients underwent adjuvant chemotherapy after surgery. Demolition of the bladder, prostate and seminal vesicles was made by both an ascending and descending manoeuvre, and was sectioned just below the veru montanum to spare the external urinary sphincter. In 7 patients we followed Walsh's technique to spare neurovascular bundles. 60 to 62 cm of small intestine was selected for reservoir construction, stopping 20-30 cm before the ileo-cecal valve. Particular care was adopted for construction of the antireflux nipple valve; uretero-ileal anastomosis was made following Wallace's technique. Mean term of surgery was 6 hours. Sovrapubic cystostomy was removed after 8 days, and urethral catheter after 21 days. After a mean follow up of 3-30 months our results are the following: 2 patients deceased for a pelvic relapse and general metastasis. In one patient we had a neoplastic relapse just on the ileo-urethral anastomosis, so permanent catheterism was necessary.