Le bag: total replacement of the bladder using an ileocolonic pouch.

Creation of an ileocolonic pouch for total bladder replacement is described in 4 patients, resulting in a highly compliant, low pressure bladder. Previous experience with bowel segments for bladder augmentation and replacement have been plagued by unpredictable bowel contractions with urinary incontinence as well as potential for renal damage. A reliable method to achieve a highly compliant, low pressure system requires disruption of directional bowel peristalsis, which this technique has succeeded in achieving. The operative technique, bowel dynamics, renal status and clinical results are described. The ileocolonic pouch offers a low pressure reservoir for total replacement of the bladder in selected patients.