Total Bladder Replacement in the Male and Female Using the lleocolonic Segment (LeBag)

Abstract

A group of 11 patients, 2 female and 9 male, underwent total bladder replacement using the ileocolonic segment (LeBag technique) with anastomosis of the bowel to the urethra. The diagnosis was invasive bladder cancer in 10 patients and severe intractable interstitial cystitis in 1. The surgical technique in the male patients was modified to simplify the procedure. The 2 female patients underwent insertion of an artificial sphincter around the bowel segment for a continence mechanism. One patient died 6 weeks post-operatively from a severe coagulopathy. Five of the 9 male patients are continent day and night, relying on their own residual sphincter mechanism, but the remaining 4 required insertion of the artificial urinary sphincter to achieve social continence. The surviving female patient is totally continent. All patients have voiding intervals of 4 to 6 h during the day and are thus continent both day and night, but in some cases the artificial sphincter was necessary to achieve this. Loss of the normal bladder-sphincter reflexes following cystectomy may account for the high incidence of nocturnal incontinence observed in most series. Total bladder replacement is now possible in both male and female patients, thus avoiding an abdominal stoma.

A Review of the Complications and Results of Implantation of the AMS Artificial Urinary Sphincter

“…The world literature appears to include reports on 2,606 patients implanted with the AMS 800 [41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82]. The literature also includes anecdotal reports of its usage in patients with renal transplantation [58], pregnancy [60, 79]and overoptimistic reports [51]of implantation in conjunction with penile implants [51, 72].…”

Functional Bladder Replacement after Radical Cystectomy in the Female: Experimental Investigation of a New Concept

“…For male cystectomy patients, the original goal of achieving continent, stomafree drainage has been realized by attaching low-pressure intestinal pouches to the urethra [15][16][17][18][19][20][21], In female pa tients too much of the intrinsic continence mechanism is removed to achieve continence by simple attachment of a common pouch to the urethra. Therefore subtotal cystec tomy techniques (leaving behind parts of the original bladder neck) or implantation of an artificial sphincter is necessary to achieve a functional neobladder that enables the patient to void at convenient intervals [22,23].…”

Bladder replacement in women: A new experience

“…The risk is so very great that some authors include acceptance of and ability to self-catheterize among their indications for bladder substitution. One of the first reports of bladder substitution in women was made by Light et al, who used the LeBag technique [134]. However, in this early report of 2 women a small portion of the trigone was used for the anastomosis to the intestine, and above all an artificial sphincter was adopted.…”