A comparison of the W-stapled ileal reservoir with hand-sewn reservoirs for orthotopic bladder replacement.

OBJECTIVES

Confidence has increased in the use of an orthotopic reservoir to the urethra after a cystoprostatectomy for bladder cancer; however, many surgeons would welcome a method to simplify the operative procedure. The availability of absorbable staples on a GIA stapler allows study of the incorporation of stapling procedures into formation of a reservoir. Because of the success of hand-sewn W-configured ileal reservoirs, we initiated a Phase II study to evaluate absorbable staples in formation of a W-configured reservoir. We now present an expanded contemporary series comparing a W-stapled ileal neobladder with hand-sewn ileal (Studer) or hand-sewn ileocolic (Le Bag) reservoirs.

METHODS

Forty-five selected patients underwent orthotopic urinary diversion after cystoprostatectomy for bladder cancer (n = 42) or prostate cancer (n = 3) using one of the three methods of reservoir construction. There were 43 men and 2 women. The evaluation included a urodynamic evaluation and a questionnaire sent to patients inquiring about urinary function.

RESULTS

Most patients did well with the W-stapled ileal reservoir but 6 of 19 evaluable patients had unsatisfactory reservoir characteristics. Three patients needed an augmentation cystoplasty and 3 had higher pressure, smaller volume reservoirs. Reservoir function appeared to be consistently more favorable in patients with either of the hand-sewn reservoirs using an ileal or ileocolic segment.

CONCLUSIONS

Although the W-stapled ileal reservoir is safe and allows reservoir formation quickly, the inconsistencies of the results discourage its use in the particular configuration described. Failure of the reservoir to distend could be a function of reservoir design, areas of ischemia in the reservoir, or reaction to staple material. Absorbable staples on the GIA instrument may work satisfactorily for formation of an ileocolic reservoir for continent cutaneous diversion. However, the W-configured orthotopic reservoir as constructed using absorbable staples in this study is inferior to a hand-sewn ileal or ileocolic neobladder.