Results of application of orthotopic urine diversion according to Studer

Abstract

Introduction: Prolonged survival of patients undergoing radical cystectomy due to the infiltrative carcinoma of the urinary bladder has increased the need for development of the orthotopic bladder enabling preservation of the upper urinary ways for the extended period of time. Orthotopic bladder with tubular afferent segments in which ureters are implanted without antireflux mechanism has been introduced into the practice in 1984 by Studer and collaborates. Material and methods: In the period 1998-2007 12 patients averagely aged 62 years were subjected to orthotopic derivation from ileum, when low-pressure reservoir was constructed and the ureters were implanted into the afferent non detubularized segment of ileum without antireflux mechanism. The follow-ups included determination of serum creatinine level, ultrasound monitoring of the upper urinary ways condition in three-month intervals and pyeloureterography with intravenously applied contrast medium one year after the surgery. Immediately before the follow-up examinations, the patients were asked to complete voiding and incontinence onset diary. Results: Complete exclusion of the kidney that was in the stasis before surgery was evidenced only in one case, in a patient with tumor infiltration of the ureteral orifice. Significant obstruction of the ureteroileal anastomosis was found in 4 renal units and it was resolved by antegrade balloon catheter dilatation. Diurnal continence was established in all patients within the initial 6 months after the surgery. Mild form of nocturnal incontinence persisted in 33% of the patients. Stenosis of the urethrovesical anastomosis was a cause of urine retention in 1.8% of patients and it was endoscopically resolved. Conclusion: The advantage of implantation into the afferent non detubularized segment of ileum over the antireflux mechanism has been verified in our study based on the low percent of stenoses.