Orthotopic replacement with hemi-Kock or W
Ghoneim, M.A.
Chirurgia Italiana 49(7): 17-23
1997
ISSN/ISBN: 0009-4773 PMID: 9424410 Document Number: 480007
Since 1986 we have used the orthotopic substitution technique on some 280 male patients suffering from bladder carcinoma and 38 females. There is minimal morbidity and mortality, though patients are generally younger than those seen in Europe and the USA. Postoperative daytime continence is experienced by about 94% of patients and night-time continence by around 78%. Since some complications were encountered using the hemi-Kock's pouch, we devised an orthotopic bladder substitute from 40 cm of ileum, using no staples and without creating a nipple. The ileum is arranged in a W formation, the ante-mesenteric border is incised and the serosa of the two lateral limbs joined together. Two troughs are created on either side of the neo-bladder and each ureter is laid into its respective trough. The mucosa on either side is sutured in front of the ureter creating a tunnel. Some 87 male patients have undergone this revised procedure, and female patients, when the urethra can be utilised.