Orthotopic bladder substitution in women using the ileal neobladder.
Before 1990, orthotopic bladder substitution was limited to men and urethrectomy was routinely performed in women--making orthotopic reconstruction impossible. Following studies on pelvic exenteration for transitional cell bladder cancer patients, and after anatomic studies of the female urethra, the first report on orthotopic bladder substitution was published in 1994. Here, we present our ileal neobladder technique, which was applied for the treatment of bladder cancer in three women, and sigmoid colon cancer with vesical metastasis in one woman. This surgical procedure preserves the urethral sphincter, the endopelvic fascia, and the pubourethral ligaments. The innervation of the sphincter is also maintained. A 45-cm segment is isolated from the distal ileum and arranged in a W-shaped configuration. An anastomosis between the ileal bladder and the urethra is made and an antireflux ureteroileal implantation is created. Postoperatively, all patients reported daytime continence. The average urinary flow rate was 13.5 +/- 2.1 mL/sec 3 months after surgery. The reservoir had low pressure and high capacity. There was no reflux or deterioration of renal function. In properly selected female patients undergoing radical cystectomy, an ileal neobladder is now an option.