Five-year experience with ileal neobladder according to original and modified Hautmann method

摘要

Introduction. Radical cystectomy is the method of treatment of muscle invasive tumor of the urinary bladder, T2-T4a, N0-Nx, M0, which is also performed in patients at high risk of superficial tumors G3, CIS (carcinoma in situ), which are resistant to BCG and diffuse papillary tumors which can not be controlled by conservative treatment. After radical cystectomy, an adequate derivation of the urine is needed, and in the best interest for patient’s comfort, is to make a new bladder from the parts of gastrointestinal tract and suture it to the rest of the urethra. In 1988, German surgeon Richard Hautmann published his method of creating a new bladder, for what he used 60cm of ileum. This method is in use at Department of Urology, Military Medical Academy, Belgrade, but, we introduced our modification of original operation because of early and late postoperative complications. Objective. The analysis of early and late complications after derivative surgery of orthotopic ileal bladder according to Hautmann. The patients operated According to original and modified method were analyzed. Method. From 2000-2004, 117 radical cystectomies were performed due to malignant urinary bladder tumors as well as the same number of derivative surgeries at the Clinic for Urology, Military Medical Academy, Belgrade. During this five-year period, the orthotopic ileal neobladder surgery according to Hautmann was performed in 41 patients after radical cystectomy. Twenty three patients were operated on using the original method and 18 patients by our modification. Results. Metabolic disorders and problems of high capacity of neobladder were manifested in all patients operated on by original method, while the stenosis of the ureteroileal anastomosis was present in most of these patients. Metabolic disorders were less frequent and of lower degree in patients operated by our modification and there was no stenosis of the ureteroileal anastomosis. The problems with urination were not reported. Conclusion. In our opinion and on the basis of our experience, Hautmann method is the method with fewer complications. However, our modifications are also acceptable because the number of complications is smaller and the value of operation is being kept.