Modalities for reconstruction of the bladder reservoir after pelvic exenterative operations

E. Brătilă, B. Liedl, C. Coroleucă, D. Comandaşu, C. Coroleucă

Abstract: Currently there are four feasible options for lower urinary tract reconstruction in radical interventions for gynaecological neoplasms: an incontinent form involving skin deflection, a continent skin reservoir requiring catheterization via stomy, continental rectal reservoir with storing and eliminating urine through the rectum and a continent neobladder with antireflux mechanism. We will present the case of a urethral tumor recurrence in a patient after total hysterectomy with bilateral anexectomy for moderately differentiated endometrial neoplasm and surgical conduct for bladder reconstruction and maintenance of the patient’s continence. There are several aspects to be considered when a bladder reconstruction is performed: the ability to develop a low pressure reservoir with an effective antireflux mechanism that protects the upper urinary tract, a suitable mechanism for storing urine, and providing the necessary vascularity to prevent complications. The benefits of this surgical intervention in patients with radical interventions for oncological indication are related to the maintenance of the continence and the preservation of the quality of life. There are methods that are not continent such as the Bricker bag or ureterostomy and methods that preserve the continence: apendicular reservoir and methods of reconstruction with ileal segment and umbilical stomy. Orthotopic neobladder with T antireflux mechanism is a feasible option of maintaining continence in patients with bladder reconstruction.
DOI:10.18643/gieu.2018.72

Keywords: reconstructive surgery, bladder reconstruction, ileal reservoir, genital neoplasm.