The Application Of Ileum In Urological Reconstruction: Experience With 11 Patients

Objective To explore the research progress of ileum related applications in urological reconstruction and provide our helpful experience to the clinical work in urology.Methods A retrospective review of the dada from 11 patients treated with orthotopic ileal neobladder reconstruction(7 cases) and ileal ureter substitution(4 cases) between July 2012 to February 2016 in our hospital. Indications, preoperative diagnosis, techniques, complications are reported and analyzed.Results 11 cases successfully completed the surgery. Radical cystectomy and orthotopic ileal neobladder construction were performed in 7 cases and early complications occurred in 3,including urine leakage with pulmonary infection(1 case), lymphatic fistula(1 case), and incision infection(1 case). In these 7 cases three months’ follow-up is performed for 6 patients after the surgery, which shows night incontinence in 4 cases and daytime continence in 6. No other complications have been observed and all patients are satisfied with current quality of life. 4 cases underwent the ureter replacement using a segment of ileum separately applied by the traditional way of ureter substitution and the other way according to the Yang-Monti principle. After the replacement, 1 case suffered with urinary tract infection and 3 other cases recovered well.Currently, all of the 4 cases show a promising renal function result.Conclusion Orthotopic ileal neobladder construction is a safe and feasible procedure of continent urinary diversion with less postoperative complications and good quality of life which is easy to be accepted; Ileal ureter replacement is one of the effective way for treatment of long ureteral defect. The classic technique of its application has been widely used because of the affirmative results. However, the ureter substitution using Yang-Monti principle, which probablely improves the postoperative condition, is worthy of further promotion.