1175 THE “I-POUCH” FIRST RESULTS OF A NEW ILEAL NEOBLADDER TECHNIQUE
2012-04-01

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20121175 THE "I-POUCH" FIRST RESULTS OF A NEW ILEAL NEOBLADDER TECHNIQUE Georgios Gakis, Mohamed F. Abdelhafez, Tilman Todenhöfer, and Arnulf Stenzl Georgios GakisGeorgios Gakis Tuebingen, Germany , Mohamed F. AbdelhafezMohamed F. Abdelhafez Tuebingen, Germany , Tilman TodenhöferTilman Todenhöfer Tuebingen, Germany , and Arnulf StenzlArnulf Stenzl Tuebingen, Germany View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1399AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The "I-pouch", a new ileal neobladder technique, uses approximately 40cm of terminal ileum for the formation of a cross-folded reservoir ("Goodwin-pouch") with a U-shaped ileal plate (each limb of 20cm length). The spatulated and conjoined ureters are implanted in an approximately 8cm subserosal trough (according to the Wallace technique) at the upper end of the U-ileal plate thereby forming an antireflux mechanism. In this analysis, we report the first functional and oncological results. METHODS A total of 97 I-pouch ileal neobladders (78 males, 19 females) were performed in patients undergoing radical cystectomy for bladder cancer between 2002-2011. We assessed the urethral recurrence rate, different functional parameters and major complications according to the Clavien-classification. The median follow-up was 30 months (3-80). RESULTS Median age at radical cystectomy was 65 years (range: 42-84). Urethral recurrence occurred in 3 of the 97 patients (3.1%). The mean postoperative post-void residual urine volume was 20ml (median: 0, range: 0-200) with 2 of the 97 patients (2.0%; 1 male, 1 female) requiring clean intermittent catheterization on a regular basis. Mean postoperative serum creatinine level was 1.1 mg/dl (median: 1.0, range: 0-5-2.6). Mean neobladder capacity was 400ml (range: 150-500ml). One of the 97 patients developed reflux into the kidneys (1.0%). Median number of urinary tract infections per year was 0 (mean: 0.4, range: 0-2). In the 97 patients, a total of 16 major complications (≥III) occurred in 16 patients (16.5%) within the 90-day postoperative interval. Of these 16 complications, 7 were due to ureterointestinal stenosis (overall stricture rate: 7.2%) requiring endoscopic (placement of double-J-stent, N=5) or open surgical management (N=2). CONCLUSIONS Based on the results of this analysis, the functional, oncological and perioperative outcomes of the "I-pouch" neobladder technique are comparable to other established ileal neobladder techniques. In addition, the differences to other ileal reservoirs are that the length of ileum is reduced to 40cm and that the directly implanted ureters lie on the dorsal wall of the pouch which facilitates instrumentation of the upper tract at a later point. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e476 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Georgios Gakis Tuebingen, Germany More articles by this author Mohamed F. Abdelhafez Tuebingen, Germany More articles by this author Tilman Todenhöfer Tuebingen, Germany More articles by this author Arnulf Stenzl Tuebingen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...