Ileal Neobladder Construction Research Articles

Compartment Syndrome Caused by a Hyperextension Position after Open Radical Cystectomy with Hautmann Ileal Neobladder Construction: A Rare Case of Rhabdomyolysis

Compartment syndrome (CS) is caused by an excessive increase in compartment intramuscular pressure, which measurement is the reference diagnostic tool. We examine the case of a 44yearold man with invasive bladder cancer who underwent an open radical cystectomy. After extubation, the patient is transferred from the operating room to the Intermediate Care Unit, where he complains of severe lumbar pain on a visual analog scale of 10 that is unresponsive to opioids and is diagnosed with rhabdomyolysis due to compartment syndrome. Multidisciplinary care and multimodal analgesia approaches were used; no fasciotomy was performed; and a favourable outcome was achieved.

Oncological and functional outcomes of female reproductive organ-sparing radical cystectomy and ileal neobladder construction.

To examine the oncological and urinary functional outcomes of reproductive organ-sparing radical cystectomy (ROS-RC) and U-shaped ileal neobladder construction in females compared with male patients. We retrospectively examined 357 patients (281 male and 76 female) with muscle-invasive bladder cancer who were treated with RC plus U-shaped ileal neobladder construction between May 1996 and July 2021. All female patients were treated with ROS-RC. We compared disease-free survival (DFS), cancer-specific survival (CSS), overall survival (OS), and urinary functional outcomes between male and female patients. We evaluated the effect of gender on DFS, CSS, and OS. Furthermore, urinary functional outcomes were evaluated in 140 males and 48 females using a pressure-flow study at 3, 6, 9, and 12 months postoperatively. Female patients were considerably older than male patients at the time of radical cystectomy. No significant difference was noted in the tumor stage preoperatively. The multivariable Cox regression analysis with an inverse probability treatment weighted model revealed that the female gender was not significantly related to DFS, CSS, and OS. Moreover, urinary functions at 12 months were not markedly different between males and females, except for the capacity of the neobladder, detrusor pressure, and maximum urethral closure pressure. This study demonstrates that female patients with ROS-RC and U-shaped ileal neobladder construction did not significantly correlate with worse oncological outcomes. The combination of ROS-RC and U-shaped ileal neobladder construction might attain adequate urinary function without sacrificing oncologic outcomes.

Laparoscopic Surgery with Indocyanine Green Fluorography and Intracorporeal Reconstruction for Ascending Colon Cancer after IlealNeobladder Construction: A Case Report

Laparoscopic Surgery with Indocyanine Green Fluorography and Intracorporeal Reconstruction for Ascending Colon Cancer after IlealNeobladder Construction: A Case Report

Tissue-engineered autologous peritoneal grafts for bladder reconstruction in a porcine model

Ileal neobladder construction is a common treatment for patients with bladder cancer after radical cystectomy. However, metabolic disorders caused by transposed bowel segments occur frequently. Bladder tissue engineering is a promising alternative approach. Although numerous studies have reported bladder reconstruction using acellular and cellular scaffolds, there are also disadvantages associated with these methods, such as immunogenicity of synthetic grafts and incompatible mechanical properties of the biomaterials. Here, we engineered an autologous peritoneal graft consisting of a peritoneal sheet and the seromuscular layer from the ileum. Three months after the surgery, compared with the neobladder made from the ileum, the reconstructed neobladder using our new method showed normal function and better gross morphological characteristics. Moreover, histopathological and transcriptomic analysis revealed urothelium-like cells expressing urothelial biomarkers appeared in the neobladder, while no such changes were observed in the control group. Overall, our study provides a new strategy for bladder tissue engineering and informs a variety of future research prospects.

Intracorporeal laparoscopic U-shaped ileal neobladder construction with three ports: a pilot study.

IntroductionRadical cystectomy is one of the most complex operations in urology, in which orthotopic ileal neobladder construction is an important part. With the development of laparoscopic instruments and surgical techniques, laparoscopic radical cystectomy has been shown to be feasible and safe and has obvious benefits. However, intracorporeal laparoscopic U-shaped ileal neobladder construction with three ports is rarely reported.AimTo share our experience in intracorporeal laparoscopic U-shaped ileal neobladder construction with three ports in patients with bladder cancer and explore the feasibility, safety and benefits of this procedure.Material and methodsFrom January 2018 to December 2019, 32 patients with bladder cancer underwent laparoscopic intracorporeal radical cystectomy and orthotopic neobladder. In this article, complete intracorporeal U-shaped ileal neobladder construction with three ports will be presented.ResultsThe median estimated intraoperative blood loss was 130 ml. The median total operative time was 270 min, and ileal reservoir construction and anastomosis required 93 min. The median time to recovery of intestinal function following the operation was 3 days. At a median follow-up of 13 months, 8 patients had hydronephrosis.ConclusionsIntracorporeal laparoscopic U-shaped ileal neobladder construction with three ports is feasible and safe. This procedure is less invasive and is highly beneficial for patients with difficulty with anastomosis of the ileum and urethra due to high mesenteric tension.

PT400 - Presence of transient hydronephrosis immediately after surgery has a limited influence on renal function 5 years after ileal neobladder construction

PT400 - Presence of transient hydronephrosis immediately after surgery has a limited influence on renal function 5 years after ileal neobladder construction

PD55-05 ASSOCIATION BETWEEN TRANSIENT HYDRONEPHROSIS 1 MONTH AFTER SURGERY AND RENAL FUNCTION 5 YEARS AFTER ILEAL NEOBLADDER CONSTRUCTION

You have accessJournal of UrologyBladder Cancer: Invasive V (PD55)1 Apr 2020PD55-05 ASSOCIATION BETWEEN TRANSIENT HYDRONEPHROSIS 1 MONTH AFTER SURGERY AND RENAL FUNCTION 5 YEARS AFTER ILEAL NEOBLADDER CONSTRUCTION Takuma Nairta*, Shingo Hatakeyama, Hayato Yamamoto, Atsushi Imai, Takahiro Yoneyama, Yasuhiro Hashimoto, and Chikara Ohyama Takuma Nairta*Takuma Nairta* More articles by this author , Shingo HatakeyamaShingo Hatakeyama More articles by this author , Hayato YamamotoHayato Yamamoto More articles by this author , Atsushi ImaiAtsushi Imai More articles by this author , Takahiro YoneyamaTakahiro Yoneyama More articles by this author , Yasuhiro HashimotoYasuhiro Hashimoto More articles by this author , and Chikara OhyamaChikara Ohyama More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000965.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract obstruction and postoperative hydronephrosis are risk factors for renal function deterioration after orthotopic ileal neobladder construction. However, reports of a relationship between transient hydronephrosis and renal function are limited. Therefore, we compared the grade of postoperative hydronephrosis to renal function in patients that underwent ileal neobladder construction. METHODS: Between March 1996 and July 2013, we performed radical cystectomy and orthotopic ileal neobladder construction in 204 patients. Of these patients, 50 patients were enrolled in the study based on data availability. The hydronephrosis grade of each kidney was evaluated by computed tomography and scored on a scale grade 0 (none) to 4 (high-grade) (Fig.1A). Renal function was evaluated before and after surgery using estimated glomerular filtration rates (eGFR). The patients were divided into four groups according to their hydronephrosis grades: no, low, intermediate, and high (Fig.1B). We compared the postoperative hydronephrosis grade to renal function for five years after surgery. RESULTS: There were no significant differences in renal function before surgery among the groups. One month after surgery, the presence of hydronephrosis was significantly associated with deteriorating renal function (Fig. 2A). However, one year after surgery, hydronephrosis grades were significantly improved (Fig. 2B), and differences in renal function were not observed among the groups until five years after surgery (Fig. 2C). Multivariate logistic regression analysis showed transient hydronephrosis was not significantly associated with eGFR<60 mL/min/1.72m2 at five years after ileal neobladder construction. CONCLUSIONS: The presence of transient hydronephrosis immediately after surgery may have a limited influence on renal function five years after ileal neobladder construction. Source of Funding: This work was supported by the Japan Society for the Promotion of Science (No. 23791737, 15H02563, 15 K15579, 17 K11118, 17 K11119, 17 K16768, 17 K16770, and 17 K16771). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1183-e1184 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takuma Nairta* More articles by this author Shingo Hatakeyama More articles by this author Hayato Yamamoto More articles by this author Atsushi Imai More articles by this author Takahiro Yoneyama More articles by this author Yasuhiro Hashimoto More articles by this author Chikara Ohyama More articles by this author Expand All Advertisement PDF downloadLoading ...

Association between Development of Metabolic Acidosis and Improvement of Urinary Continence after Ileal Neobladder Creation.

Ileal neobladder construction is a common choice for orthotopic urinary diversion following radical cystectomy. We investigated risk factors for metabolic acidosis during the early recovery period. This study relied on retrospectively collected data on 345 patients who underwent inpatient rehabilitation after radical cystectomy and ileal neobladder construction for bladder cancer between January 2014 and March 2017. Acid-base status, use of sodium bicarbonate to correct metabolic acidosis and continence status were evaluated at the beginning and end of 3 weeks of inpatient rehabilitation. Multivariate logistic regression analysis was performed to identify risk factors associated with the development of metabolic acidosis. At the start of rehabilitation a median of 29 days after surgery (IQR 23-37) 200 patients (58.0%) had metabolic acidosis. During the inpatient rehabilitation period the need for oral sodium bicarbonate replacement due to acidosis increased significantly from 45.2% to 86.7% of patients (p <0.001) while urine loss measured by a 24-hour pad test decreased significantly from a median of 387 (IQR 98-918) to 88 gm (IQR 5-388, p <0.001). The median base excess was within the normal range (-1.2 mmol/l, IQR -2.4 - 0.0) at the end of inpatient rehabilitation. Decreased urinary leakage was identified as an independent risk factor for metabolic acidosis.Conclusions:The risk of metabolic acidosis after neobladder construction correlated with continuously improved continence in the early recovery period. Therefore, during this period the acid-base status should be assessed more frequently to identify metabolic acidosis.

The surgical technique and initial outcomes of Anatolian neobladder: a novel technique of ileal neobladder after radical cystectomy

BackgroundWe describe a detailed novel step-by-step approach for creation of an ileal neobladder and compare the outcomes with standart neobladder.MethodsBetween August 2009 and January 2016, 36 consecutive patients with bladder cancer underwent radical cystectomy and orthotopic urinary diversion with an ileal neobladder. A novel technique of ileal neobladder construction, called the Anatolian neobladder, was designed by a single surgeon (ZT). Demographics and clinical data were collected. Perioperative, oncologic, and functional outcomes were reported. Complications were graded as early or late. These outcomes were compared with patients who underwent standard neobladder during this period in our center.ResultsThe operation was technically successful in all cases. Early postoperative complications occurred in 33.3% of the patients. Daytime continence was achieved successfully in 83.3% of the patients. No patient had severe metabolic acidosis. Six patients (16.6%) died during follow-up, five due to metastatic bladder cancer and one due to a cardiac problem. There was no any statistically significant difference between novel technique and standard neobladder for oncological and functional outcomes.ConclusionsThe Anatolian ileal neobladder is as feasible and safe as standard neobladder technique for urinary diversion in patients with bladder cancer undergoing radical cystectomy.

Orthotopic ileal neobladder reconstruction in a woman who developed squamous cell carcinoma of the urinary bladder after kidney transplantation.

The case of a 62-year-old woman who developed squamous cell carcinoma of the bladder 16 years after a kidney transplant is reported here. After the transplant, immunosuppressive therapy was maintained with cyclosporin A (200 mg/day) and the patient's serum creatinine level was 0.9 mg/dL. She was diagnosed with squamous cell carcinoma of the bladder 16 years later and underwent radical cystectomy with an orthotopic ileal neobladder. The Studer technique was used and the afferent ileal loop was anastomosed to the graft ureter. The postoperative course was uneventful. At the 6-month follow-up visit, the patient showed no evidence of recurrence. Her serum creatinine level was 1.0 mg/dL. The patient was continent during the day and the night. This case shows that the construction of an orthotopic ileal neobladder after cystectomy is safe and feasible in kidney transplant recipients.

Presence of transient hydronephrosis immediately after surgery has a limited influence on renal function 1\xa0year after ileal neobladder construction

BackgroundUrinary tract obstruction and postoperative hydronephrosis are risk factor for renal function deterioration after orthotopic ileal neobladder construction. However, reports of relationship between transient hydronephrosis and renal function are limited.We assess the influence of postoperative transient hydronephrosis on renal function in patients with orthotopic ileal neobladder construction.MethodsBetween January 2006 and June 2013, we performed radical cystectomy in 164 patients, and 101 received orthotopic ileal neobladder construction. This study included data available from 64 patients with 128 renal units who were enrolled retrospectively. The hydronephrosis grade of each renal unit scored 0–4. The patients were divided into 4 groups according to the grade of hydronephrosis: control, low, intermediate, and high. The grade of postoperative hydronephrosis was compared with renal function 1 month and 1 year after surgery.ResultsThere were no significant differences in renal function before surgery between groups. One month after surgery, the presence of hydronephrosis was significantly associated with decreased renal function. However, 1 year after urinary diversion hydronephrosis grades were improved significantly, and renal function was comparable between groups. Postoperative hydronephrosis at 1 month had no significant influence on renal function 1 year after ileal neobladder construction. Limitations include retrospective design, short follow-up periods, and a sample composition.ConclusionsThe presence of transient hydronephrosis immediately after surgery may have limited influence on renal function 1 year after ileal neobladder construction.

An improved technique for bladder cancer: Pure laparoscopic radical cystectomy with orthotopic U-shape ileal neobladder using titanium staples

ObjectiveTo report our experience with an improved technique of laparoscopic radical cystectomy (LRC) and orthotopic ileal neobladder reconstruction, evaluating the perioperative and pathological outcomes. MethodsWe retrospectively reviewed the data of 56 cases who underwent radical cystoprostatectomy followed by construction of an orthotopic U-shaped ileal neobladder between August 2010 and December 2014. These data include intraoperative data, early and long-term postoperative complications, neobladder function, urinary continence and oncologic results. Also the key innovative procedure was introduced with details. ResultsThe median time of the overall procedure was 212 min. The median estimated blood loss was 171 ml. The median hospitalization time after the operation was 21 days. Complications included two cases of unilateral ureter-pouch anastomotic strictures, one case of bilateral ureteral stricture, three cases of vesicourethral anastomotic strictures and three cases of vesicourethral leakage. The mean maximum pouch capacity was 446 ± 32 ml, and pouch pressure at capacity was 18.1 ± 2.6 cm H2O. The Qmax was 14 ± 1.2 ml/s, and the mean postvoid residual was 25 ± 10 ml. There were 9 cases of night-time incontinence at 3 months post-operatively. Negative surgical margins of the bladder specimens were achieved in all patients. During a follow-up period of 3–44 months (average 32.6 months), local recurrence was found in two patients and distant metastasis was occurred in another 3 patients. ConclusionsOur preliminary experience showed that pure LRC with nonabsorbable titanium staples assisted orthotopic U-shape ileal neobladder reconstruction is feasible based on perioperative data and oncologic features.

278 Presence of transient hydronephrosis at 1 month after surgery has no significant impact on renal function at 1 year after ileal neobladder construction

INTRODUCTION AND OBJECTIVES: Risk of renal insufficiency has historically been viewed as a long-term consequence of urinary diversion after radical cystectomy. There is, however, little data comparing long-term rates of end-stage kidney disease (ESKD) in patients who have had a cystectomy in the setting of bladder cancer. We evaluated the risk of end stage kidney disease (ESKD) in patients who received ileal conduit versus continent urinary diversion after cystectomy for bladder cancer using a large population cohort. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset, we identified 4,511 patients who underwent radical cystectomy for bladder cancer, excluding those with pre-existing renal disease. The outcome of interest was the development of ESKD, stratified according to diversion type (continent vs. conduit diversion) while controlling for multiple factors including Charlson comorbidity score, age, and grade/stage of tumor in multivariate logistic regression models. Median follow up was 41 months (interquartile range1⁄419-78 months). RESULTS: Two hundred fifty patients (5.4%) developed ESKD. 83% of the patients received ileal conduit, and 17% received continent urinary diversion. On multivariate analysis, when controlling for known confounders, there was no increased risk of developing ESKD associated with a continent diversion (HR 0.85, 95% CI 0.60-1.19). Charlson co-morbidity score 1 predicted risk of developing ESKD compared with patients of Charlson score of 0 at time of cystectomy (HR 1.55, 95% CI 1.19-2.02, p 0.001). 5-year and 10-year cancer-specific and overall survival were higher in those who received continent urinary diversion (p<0.0001). CONCLUSIONS: Continent urinary diversion does not portend increased risk of ESKD compared to ileal conduit. This data suggests that co-morbidities at time of cystectomy, rather than age or type of diversion, increased the risk of ESKD in patients undergoing cystectomy. Continent urinary diversion was also associated with improved overall survival compared with those receiving ileal conduit, likely secondary to selection bias not completely controlled for with Charlson comorbidity Index and age.

Conservative management of a delayed neovesicocutaneous fistula.

A neovesicocutaneous fistula is a rare complication after orthotopic bladder reconstruction, particularly in the late postoperative period. We report the case of a 59-year-old man who had undergone ileal neobladder construction 17 months previously. He presented with urinary retention concomitant with urinary tract infection due to a neovesicourethral anastomotic stricture. After a combination of transurethral catheter drainage and broad-spectrum antibiotic therapy for 3 weeks, the fistulous tract completely closed. Therefore, conservative treatment may be regarded as a valid option for a delayed neovesicocutaneous fistula.

Abdominal compartment syndrome following opioid-induced postoperative ileus

A 35 year old woman, 6 days after ileal neobladder construction, reported uncontrolled pain despite 33 mg hydromorphone via patient-controlled analgesia (PCA). Abdominal compartment syndrome was suspected based on worsening tachypnea, oxygen desaturation, and severe, prolonged ileus. Following emergent intubation, peak airway and bladder pressures were elevated. After nasogastric decompression, they returned to normal. Continuous ketamine infusion was used for opioid resensitization and the patient was extubated following return of bowel function. Opioid use contributed to the ileus, caused gastric distension, and displaced the diaphragm cephalad. The patient interpreted the subsequent dyspnea as pain and increased PCA opioid use, thereby worsening the ileus.

Ileal Urinary Reservoir in Pediatric Population: Objective Assessment of Long-term Sequelae With Time-to-event Analysis

To evaluate the long-term outcomes of an ileal urinary reservoir in children. This was a longitudinal study of pediatric patients who had undergone total ileal substitution of the bladder. Continence status was assessed, and all patients were evaluated for kidney function and biochemical profile. Standardized growth charts were used to assess linear growth. To assess bone mineral density, dual-emission x-ray absorptiometry scanning was performed. Clavien's scale was used to report and grade the long-term complications and their timing. We used a simple quality of life questionnaire to assess the effect of the procedure on the quality of life of the growing child. A total of 17 patients were included; 3 with orthotopic and 14 with continent cutaneous reservoirs. After a mean follow-up of 87.3 months, all patients were voiding with clean intermittent catheterization, with a 94% final continence rate. Two patients (11.7%) had an estimated glomerular filtration rate of ≤ 45 mL/min/1.73 m(2) at the last follow-up examination. However, no clinically manifest metabolic acidosis was detected. No anemia or neurologic deficit was detected, with a low-normal serum level of vitamin B(12) in 2 patients (11.7%) and a low level in 1 patient (5.7%). One patient (5.7%) had chronic diarrhea. Low bone mineral density was found in 4 patients (22.8%), with 3 patients (17.1%) not exceeding the fifth percentile of height for age. High-grade complications (grade 3a-5) represented 64.5% of the complications, and the need for reintervention occurred late in the follow-up period. A high level of quality of life satisfaction was reported (88.5%). Ileal neobladder construction allows child to pass into adolescence dry with more confidence and self-esteem, with no external urine collection set. However, long-term follow-up is mandatory to maintain the positive outcome.

Transobturator vaginal tape (inside-out) for stress urinary incontinence after radical cystectomy and orthotopic reconstruction in women

ObjectivesTo evaluate the safety and clinical efficacy of the transobturator vaginal tape ‘inside-out’ (TVT-O) procedure for managing new-onset stress urinary incontinence (SUI) after radical cystectomy (RC) and orthotopic W-neobladder construction in women. Patients and methodsBetween January 2004 and June 2010, 57 women were treated with RC and orthotopic ileal neobladder reconstruction. Six of these patients (median age 44years, range 39–62; grade 2 muscle-invasive squamous cell carcinoma in four and transitional cell carcinoma in two) developed de novo SUI that was moderate in four and severe in two. The median (range) duration of SUI was 11 (9–18) months. All six patients underwent TVT-O for control of their SUI. ResultsFour patients were completely dry day and night (three of them can initiate voiding and one cannot, and uses intermittent catheterization). One patient improved, as assessed by using fewer pads (from 5–7 pads to 1 pad/day and night). She can initiate voiding but has minimal leakage only on moderate exertion. One patient who had severe SUI showed no improvement. Patients were followed for a mean (range) of 18 (17–32) months, with no deterioration in the continence status. ConclusionThese encouraging results confirm the safety and clinical efficacy of TVT-O for managing new-onset SUI after RC and ileal neobladder construction, although a larger survey and a longer follow-up are needed.

Laparoscopic radical cystectomy for bladder cancer with prostatic and neurovascular sparing: initial experience

This study presents our initial experience with laparoscopic radical cystectomy with preservation of the neurovascular bundles and partial prostate for the treatment of bladder cancer. Thirty-seven patients with bladder cancer were selected for the study between June 2007 and December 2009. The criteria for patient selection included prostate-specific antigen level below 4.0 ng/mL; negative involvement of the trigone and/or prostatic urethra; and no self-reported erectile dysfunction. The surgical procedure included laparoscopic prostate- and neurovascular bundles-sparing cystectomy with an ileal neobladder construction. Mean follow-up was 18 months. All patients underwent laparoscopic resection without requiring a traditional open procedure. The mean operation time was 215 min with a mean volume of intraoperative hemorrhage of 190 mL. After removal of the urinary catheter, all patients had a daytime urinary continence; six had a short period of nighttime urinary incontinence. Most patients reported a strong desire for sexual activity and were able to complete sexual intercourse without auxiliary measures at 3 months postoperatively. Grade-3 complications developed in 2 patients graded by the classification of Clavien system. One patient was diagnosed with pelvic recurrence 16 months postoperatively. The laparoscopic radical cystectomy with a partial prostate preservation offers the advantages of a high continence, minimal impairment of erectile function, and low recurrence rate.

Editorial Comment

The surgical tenets of radical cystectomy were established years ago on the basis of our knowledge of the progression patterns of invasive bladder cancer. Early experience with less aggressive approaches made it clear that wide local excision of the bladder and its surrounding tissues, along with a thorough pelvic lymph node dissection, provides the optimal means to achieve local and regional cancer control. Because local recurrence after radical cystectomy is associated with fatal outcome, every attempt must be made to achieve cancer control. Changing the surgical technique of radical cystectomy in women to spare the gynecologic organs should be based on clear data that the change will not adversely affect cancer control and will provide a functional benefit—whether physiological, reconstructive, or psychological. Uterus-, Fallopian Tube-, Ovary-, and Vagina-sparing Cystectomy Followed by U-shaped Ileal Neobladder Construction for Female Bladder Cancer Patients: Oncological and Functional OutcomesUrologyVol. 75Issue 6PreviewTo evaluate oncological outcomes and voiding functions after orthotopic neobladder reconstruction with preservation of gynecologic organs in female bladder cancer patients. Full-Text PDF ReplyUrologyVol. 75Issue 6PreviewWe really appreciate the editorial comment. We agree with the opinion that changing the surgical technique of radical cystectomy in women to spare the gynecologic organs should be based on clear data that the change will not adversely affect cancer control and will provide a functional benefit. So we need to be very careful when we preserve gynecologic organs in radical cystectomy. However, in our opinion, gynecologic organs that are not involved with bladder cancer should not be removed. Full-Text PDF

Complete Ileal Neobladder Intracorporeal Construction With Standard Sutured Technique and Novel Technology

We compared the surgical efficacy and efficiency of a completely suture based procedure with a novel entero-urethral anastomosis device and an EndoGIA stapler to create an ileal neobladder. Two groups of 7 pigs each were survived for 8 weeks. In group 1 the neobladder was constructed using a U-shaped segment of ileum sealed with the stapler. The entero-urethral anastomosis was created with a novel sutureless anastomosis device. All other procedures were completed with standard intracorporeal suturing techniques. In group 2 animals completely intracorporeal sutured technique was used. Total procedure, and enteroenteric, ileal neobladder, uretero-enteric and entero-urethral anastomosis times were recorded. Cystograms done immediately postoperatively, at 2 weeks and at sacrifice to evaluate the newly constructed system were rated from 0-no leakage to 3-severe leakage. In group 1 vs 2 the overall procedure, and enteroenteric, ileal neobladder, uretero-enteric and entero-urethral anastomoses were completed in 285.3, 32.3, 58.8, 54.2 and 5.5 vs 350.1, 29.9, 139.1, 58.0 and 46.3 minutes, respectively. In groups 1 and 2 the average postoperative cystogram rating was 0.83 and 1.6, respectively (p = 0.63). At 2 weeks and at sacrifice cystograms showed no extravasation in either group. The overall surgical procedure, pouch creation and entero-urethral anastomosis were statistically briefer in group 1 (p = 0.036, 0.01 and 0.039, respectively). Average survival in groups 1 and 2 was 30 (range 4 to 56) and 41 days (range 1 to 56), respectively (p = 0.36). All animals had voiding complications within 1 week after ureteral and urethral catheters were removed. One neobladder ruptured in group 1. Combining stapled ileal neobladder construction and the entero-urethral anastomosis device significantly decreases operative time, pouch creation and urethral anastomoses.