"W" NEOBLADDER WITH AFFERENT SHORT LOOP

PURPOSE: to put emphasis on easiness of reconfiguration of the afferent short loop "W" reservoir and possibility to remove the distal ureteral tract often ischemic and cause of stenosis before performing an uretero-ileal anastomosis. MATERIAL AND METHODS: since 1996 to 1998 16 male patients (age 48-63 years) affected by transitional bladder carcinoma, underwent radical cystectomv and "W" ileal-neobladder construction with afferent short loop utilizing 35 centimeters of bowel for the reservoir and 7-10 cm for the afferent loop. Uretero-intestinal anastomosis according to Nesbit's technique was performed for the ureteral reimplantation removing the distai ureteral tract. For the neobladder-urethral anastomosis, the parachute technique was used with 6-8 Dexon 3-zero stiches. Average follow-up was 7 months. RESULTS: at 12 months follow-up urodynamic study showed 600ml average capacity and filling maximum pressure was 20 cm H20. 83% of the patients had diurnal continence while 58% had the nocturnal continence, voiding interval every 3-4h. We had a post-surgical ureteral stenosis treated surgically. We had no different results in terms of reflux and stenosis in comparison with Studer's afferent long loop. CONCLUSIONS: "W" neobladder with afferent short loop is a reservoir easy to be done. Afferent loop allows to remove the ureteral distai tract often ischemic reducing stenosis rate without modifying reflux, continence and micturition intervals in comparison with Studer's and Hautmann's technique and sparing of ileum. At least it is not necessary to mobilize the neobladder posterior wall for the reimplantation of the stenotic ureter.