Cystectomy with ileal bladder replacement

Radical cystectomy and ileal bladder replacement is a relatively common operation. Urinary tract diversion is an important issue faced after radical cystectomy, because urinary tract diversion will directly affect the patient's quality of life and even cause certain damage to the kidneys. After ileal bladder replacement, the patient's kidney function can be significantly improved. Before the operation, you should prepare well and understand the indications for the operation.

Preoperative preparation

Basically the same as ileal cystotomy. Pay special attention to correcting anemia, controlling urinary tract infections, improving general condition and renal function, and making adequate intestinal preparations.

Indications

1. For patients with bladder tumors who need radical cystectomy, enterocystectomy can be selected in the following situations: ① Multiple bladder tumors; ② Recurrence of bladder tumors; ③ High tumor pathological grade (grade III or grade II-III); ④ The depth of tumor infiltration does not exceed the superficial muscle layer and there is no pelvic lymph node metastasis, and no pelvic radiotherapy is required after surgery. 2. Patients with small bladder capacity due to interstitial cystitis, tuberculous cystitis, glandular cystitis, and radiation cystitis, without urethral stenosis, good external urethral sphincter function, and no obvious hydronephrosis or impaired renal function.

Contraindications

1. Patients with invasive bladder tumors whose infiltration depth exceeds the deep muscle layer or with pelvic lymph node metastasis who require pelvic radiotherapy after surgery. 2. Female bladder cancer patients after radical cystectomy. 3. Posterior urethral tumor. 4. Irreparable urethral stricture. 5. Those with obvious hydronephrosis and impaired renal function. 6. The mesentery is too short, making it difficult for the allantois to anastomose with the urethra.

General steps of surgery

1. The bladder is removed as usual and the prostate is wedge-shaped, leaving the residual capsule of the prostate in a trumpet-shaped form. 2. Cut the peritoneum open and select and free the ileum segment of 40 cm based on the blood supply of the mesentery. The two ends of the ileum are anastomosed end to end to restore the continuity of the intestine and close the mesenteric space. 3. Close the two ends of the free ileum. 4. Establish anti-reflux measures. 5. Establishment of the ileal allantois sac. 6. The ureter is anastomosed to the allantois. 7. The amniotic sac is anastomosed with the urethra.