[Low-pressure ileal neobladder formed by antimesentery section of circular smooth muscle fibers].

The goal of this presentation is to describe operative technique and first clinical results of a ileal neobladder for total bladder replacement. Creation of an ileal neobladder for total bladder replacement is described in 18 patients. To achieve a low pressure system, disruption of directional bowel peristalsis with a longitudinal incision at the antimesenteric border of a 70 cm ileal segment is performed. A spherical pouch, the neobladder, is fashioned and anastomosed to the urethra. The ureters are implanted according to Le Duc and Camey. Videourodynamic studies during various postoperative phases demonstrate this neobladder to be a urinary reservoir with a capacity approximating that of a normal bladder, good compliance during filling by maintaining pressures lower than 30 cm water and no reflux. Advantages of this procedure when compared with "Kock's pouch", "Mainz pouch", "Camey's ileal bladder" or "the Bag" are: non interference with terminal ileum and Bauhin's valve (vitamin B 12 absorption); simple, sure surgical technique giving constant results (absence of invagination, and of rotation on mesenteric axis as in Kock's pouch); sensitivity of new bladder with rhythmicity of micturition in 18 cases; lowest intracavitary pressures of all reconstructed reservoirs.