Abstract

Objectives: Clinical results of 32 patients with neo-bladder reconstruction using a W-shaped ileum segment following radical cystectomy are presented in this study. Serosa-lined extramural tunnel implantation (Ghoneim) was the preferred technique for ureteral implantation in all of the cases.

Materials and Methods: 32 male patients whose mean age was 59 (35-75) with the diagnosis of invasive bladder carcinoma with the shortest follow-up of 6 months since February 1998, were evaluated with day-time and nocturnal continence questionnaire, urodynamic study, voiding cystouretrogram, serum creatinine level and blood gas analysis, ultrasonography and intravenous pyelogram.

Results: Mean follow-up period was 18 months. One patient was lost due to dissemimated tuberculosis on the 24th post-operative day, another patient was lost due to pulmonary emboli. Temporary intestinal obstruction in 5 patients, febrile infection in 4 patients, deep vein trombosis in 2 patients and evisseration in 2 patients were observed as early complications. Symptomatic metabolic acidosis was not detected in any of the patients under follow-up. While day-time and nocturnal continence was achieved in 96.1% and 38.2% of patients respectively, none of the patients needed intermittent catheterization. Mean bladder capacity was 520cc and mean pressure was 26cmH2O in urodynamic evaluation. Reflux was not detected in any of the cystouretrograms. Mild hydronephrosis was encountered in 3 renal units.

Conclusion: With acceptable complication rate and morbidity, Ghoneim is a well preferrable technique for neo-bladder reconstruction after cystectomy.