Abstract
To describe a modified technique for orthotopic ileal neobladder preparation. The Studer technique is the method most frequently used worldwide and seems to be an ideal reconstructive solution after radical cystectomy. After radical cystectomy, urinary diversion is attained by means of a detubulized ileal segment. About 40 cm are used to create the reservoir and 15 cm for a tubular afferent limb. A spheroidal-shaped reservoir is then obtained with a conic distal part that will be anastomized to the urethral stump. After the reconstructive part, the neobladder and the afferent limb are attached to the levator ani and psoas muscles, respectively. Postoperative results on a series of 36 patients are reported. The final shape of the reservoir was roughly spherical. A small amount of anastomotic strictures was registered. Renal function was not impaired after surgery, even at late follow-up. Even if the Studer technique is already well described, we believe that our technical changes may improve urinary tract restoration, and potentially decrease complications typical of urinary orthotopic diversion. Further cases are required to confirm possible advantages of the modified technique.
Highlights
Renal function was not impaired after surgery, even at late follow-up
Even if the Studer technique is already well described, we believe that our technical changes may improve urinary tract restoration, and potentially decrease complications typical of urinary orthotopic diversion
Radical cystectomy is the gold standard of treatment of muscle invasive bladder cancer [1.2]
Summary
Surgical procedure a) Common steps with traditional Studer’s technique: After radical cystectomy and pelvic lymphadenectomy, orthotopic diversion is made through the isolation of an ileal segment 50-60 cm long (25 cm proximal to the ileocaecal valve, in order to avoid risk of vitamin B12 malabsorption or diarrhoea due to bile acid). The main difference in our technique from the original Studer depiction is that reconstruction of the anterior plane begins with the first stitch, which passes between the middle of the left side and that of the right side, we proceed with a continuous suture downwards ending at the bottom, configuring a conic neobladder neck. This passage facilitates the anastomosis between the urethral stump and neobladder. The neobladder and its afferent limb are fixed to the levator ani muscle and parietal peritoneum respectively, in order to give the reservoir a correct placement and to assure its morphological stability
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