Optimization of ileocystoplasty in bladder cancer patients after cystectomy

Introduction. Surgery remains the main method of treatment of patients with bladder cancer, and the only radical surgery is cystectomy with lymphadenectomy and a rationally selected method of urinary diversion. In the Chelyabinsk Regional Clinical Oncological Dispensary, an original method of orthotopic neobladder reconstruction in bladder cancer patients was developed.

Objective: to improve the results of surgical treatment and the quality of life of patients with bladder cancer who underwent cystectomy.

Materials and methods. The article presents results of a study of patients with bladder cancer who underwent orthotopic ileocystoplasty after radical cystectomy using a unique original technique. The reservoir was formed using a segment of the ileum of 45–50 cm in length with a 20–25 cm offset from the ileocecal junction. It’s important to preserve nutrition of the resected fragment. One of the branches of the ileocolic artery supplies blood to the distant part of the ileum which explains the necessity of the offset. After examination of the mesentery for unusual blood supply, the necessary intestinal segment was resected. Intestinal patency was restored by application of an anastomosis side-to-side with double row suture on the mucosa and serous-muscular layer. The reservoir was formed by application of an enteroenterostomy side-to-side with one row inverting continuous suture. Before that, the resected small-intestinal segment was detubulized (dissected) through the antimesenteric margin for 12–15 cm.

Results. This method has the lowest rate of complications; doesn»t affect overall, cancer-specific and recurrence-free survival.

Conclusion. The proposed method of neobladder formation allows to significantly improve the results of bladder cancer treatment.