RU2514530C1 - Method for orthotopic cytoplasty - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely oncourology. A radical cystectomy is performed. An orthotopic neobladder is formed of an ileum segment. A peritoneum is separated from an anterior wall of the rectus that is followed by its cranial traction. A hole is formed in an abdominal peritoneum in a projection of a Douglas pouch. The neobladder is brought through the hole into a cavity of the lesser pelvis. After ureters are implanted, the peritoneum is closed.

EFFECT: method provides a short path to the cavity of the lesser pelvis for the neobladder with no mesentry angulations and compressions, and limit the abdominal cavity from the lesser pelvis.

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Description

The invention relates to medicine, namely to oncourology, and may find application in the surgical treatment of bladder cancer by radical cystectomy and the formation of orthotopic neocystis.

Radical cystectomy is currently the standard surgical treatment for muscle-invasive bladder cancer, superficially low-grade (T ₁ G ₃ ) bladder cancer, in situ cancer that does not respond to intravesical BCG therapy and multiple organ damage. Today, orthotopic reconstruction of neocystis is the best form of urine derivation and can be considered the gold standard for treating patients with invasive bladder cancer [Matt S. Ashley, Siamak Daneshmand Factors influencing the choice of urinary diversion in patients undergoing radical cystectomy // BJU lnt. - 2010 .-- Vol.106. - No. 5. - R.654-657].

Orthotopic neocystis of low pressure most closely corresponds to the natural bladder both in localization and functionally. The orthotopic form of urine derivation implies natural urination, with no need for a skin stoma, urostomy devices, or intermittent self-catheterization. This form of reconstruction of artifact neocystis is possible with radical cystectomy with the preservation of the rhabdosphincter. Urination is accompanied by a simultaneous increase in intra-abdominal pressure and relaxation of the pelvic floor. Most patients after orthotopic reconstruction of the bladder retain urine and completely empty the urinary reservoir without the need for intermittent self-catheterization. Many forms of orthotopic artifactic neocystis have been described using various sections of the gastrointestinal tract (segment of the stomach, ileum, or sigmoid colon).

As a prototype for the closest technical essence, we have chosen a method of radical cystectomy and orthotopic cystoplasty without restoring the integrity of the peritoneum, i.e. the abdominal cavity and small pelvis with the artifact bladder are not delimited from each other and are a single unit [Fredrik Liedberg Early Complications and Morbidity of Radical Cystectomy // Eur. Urol. Suppl. - 2010 .-- Vol. 9. - P.25-30; Oliver W. Hakenberg. Urinary Diversion After Radical Cystectomy for Muscle-Invasive Bladder Cancer // Eur. Urol. Suppl. - 2010 .-- Vol. 9. - issue 10. - P.735-774; Wassim Kassouf, Richard E. Hautmann, Bernard H. Bochner et al. A Critical Analysis of Orthotopic Bladder Substitutes in Adult Patients with Bladder Cancer: Is There a Perfect Solution? // Eur. Urol. - 2010 .-- Vol. 58. - P.374-383].

The technique of such a conventional operation is as follows: a lower middle skin incision is made that borders the navel on the left. Perform the lower and middle median laparotomy. Urachus crosses the navel, which should be removed in a single block with the bladder. The abdominal organs are inspected to detect metastases or diseases that were not diagnosed during preoperative examination. A cut of the peritoneum in the right lateral canal, enveloping the cecum and continuing along the mesentery of the small intestine, mobilizes the blind and initial part of the ascending colon. A cut of the peritoneum in the left lateral canal mobilizes the distal part of the descending colon and sigmoid colon. The mesentery of the sigmoid colon is separated from the promontorium and the distal part of the aorta to the level of discharge of the inferior mesenteric artery, so that in the future the left ureter can be moved to the right without tension. Then, the small and blind guts are wrapped in a wet towel and moved up. The ureters are secreted to the level of the intersection with the common iliac arteries distally before flowing into the bladder. 2 cm away from the bladder, they cross. The distal ends are bandaged. Then the ureters mobilize proximal to the common iliac arteries. Dilated ureters are intubated with polyvinyl chloride tubes to drain the urine. Non-dilated ureters can be bandaged: under the influence of hydrostatic pressure of the urine during the cystectomy, they will expand, which will facilitate the imposition of ureterreservar anastomoses. Pelvic lymph node dissection begins. Removal of adipose tissue with lymph nodes located in it begins medial to n.genitofemoralis, which is the lateral border of lymphatic dissection. Complete dissection of the external iliac artery and vein is performed until bifurcation of the common iliac artery, which is the cranial border of lymphatic dissection. The caudal border of lymphatic dissection is the endopelvic fascia. After the lateral external iliac vessels are displaced, the obstructive fossa is cleaned of adipose and lymphatic tissues. The medial border of dissection is the bladder. During lymphatic dissection, a circular ligament of the uterus in women and a vas deferens in men are crossed and ligated. Allocate the side wall of the bladder. Sequentially, the upper cystic artery is crossed and ligated at the clamps, and then the lower and all tissues going to the bladder from the lateral wall to the prostate gland are first ligated. After this, the allocation of the posterior surface of the bladder and prostate gland begins. The bladder is diverted anteriorly so that the peritoneum of the rectovesical pocket is visible. The latter, bordering the bladder, is dissected. It is important that at the point of transition of the peritoneum from the bladder to the rectum, the peritoneum is dissected on the side of the rectum. Then the Denoneville aponeurosis, located between the rectum on one side and the bladder, seminal vesicles and the prostate gland, on the other, will move towards the bladder, which facilitates the secretion. Typically, the rectum with your fingers easily exfoliates from the posterior surface of the bladder and prostate. Similarly produce lymph node dissection and allocation of the side wall from the opposite side. It is more convenient for the surgeon to be on the side opposite to dissection. After completion of the allocation of the posterior and lateral walls of the bladder and prostate, proceed with the allocation of the anterior wall. The front wall of the bladder is separated from the pubic bones. The puboprostatic ligaments between which the surface branches of the dorsal vein of the penis are located are identified. Dissect the internal fascia of the pelvis. Fingers inserted into incisions of the endopelvic fascia mobilize the lateral surface of the prostate to the apex. The puboprostatic ligaments cross closer to the pubic bones. A dissector is carried out behind the dorsal venous complex in front of the urethra. The venous complex is ligated and transected, and the anterior surface of the membranous urethra becomes accessible. Immediately after the tip of the prostate, the drug is cut off from the urethra. Around the circumference of the urethra, 6 sutures are applied to complete the urethroreservoir anastomosis. Retreating 25 cm from the ileocecal angle, take a segment of the ileum 40 cm long. Continuity of the intestine is restored with an end-to-end anastomosis. The mesentery defect of the intestinal anastomosis is sutured. Along the mesenteric margin, the ileum transplant is detubularized and neocystis is formed from it. On the mesentery, transposition of neocystis into the pelvis is performed. The left ureter is passed through the mesentery of the sigmoid colon. The urethroreservoir and ureterreservar anastomoses are formed on the intubators or the stenting of one ureter and the intubator are set in the opposite direction, which is removed via the urethra with the Foley catheter. The front wall of the neocystis is sutured. The peritoneum is not sutured and, accordingly, the abdominal cavity is not delimited. The abdominal cavity forms a single whole together with the small pelvis, in which the orthotopic neocystis is located.

The disadvantages of the method chosen by us as a prototype are:

- non-physiological position of the abdominal organs, primarily the intestines. Formed orthotopic neocystis changes the anatomy of the pelvis and abdominal cavity. The mesentery of orthotopic neocystis descends into the small pelvis and forms a kind of “bridge” under which the loops of the intestines can slip and bend;

- between the walls of orthotopic neocystis and the walls of the pelvis, narrow slit-like spaces are formed, a kind of pockets into which bowel loops can bend, causing intestinal obstruction;

- the mesentery of the graft often lies on the fold of the parietal peritoneum and bends through it, which can lead to disruption of the blood supply to the formed orthotopic neocystis;

- the lack of distinction between the zone of the small pelvis and the abdominal cavity in case of insolvency of the ureterreservative anastomoses or sutures of the reservoir can lead to the development of urinary peritonitis and the need for repeated surgical interventions.

The objective of the invention is to maintain the physiological position of the abdominal cavity, the exclusion of ischemia formed orthotopic neocystis, the occurrence of adhesive-intestinal obstruction and urinary peritonitis, as well as repeated surgical interventions.

The technical result of the present invention is the creation of a direct and shortest path to the pelvic cavity for the formed orthotopic neocystis without kinks and compression of its mesentery, as well as the restoration of the integrity of the peritoneum, that is, the delimitation of the abdominal cavity from the pelvis.

The technical result of the present invention is achieved by the fact that they carry out a radical cystectomy with the subsequent formation of orthotopic neocystis from the ileum segment. The peritoneum is peeled off from the anterior wall of the rectum, its cranial traction is performed, a hole is created in the projection of the douglas space in the parietal peritoneum, which is exfoliated from the anterior wall of the rectum. A formed orthotopic neocystis is passed through the created hole into the pelvic cavity. After implantation of the ureters, the peritoneum is tightly sutured.

Distinctive essential features of the proposed method are:

- dissect the peritoneum at the transition from the bladder to the rectum, the peritoneum is peeled from the front wall of the rectum, produce its cranial traction;

- in the projection of the douglas space create an opening in the parietal peritoneum, exfoliated from the front wall of the rectum;

- conducted through the created hole formed orthotopic neocystis in the pelvic cavity;

- after implantation of the ureters, the peritoneum is hermetically sutured.

A causal relationship between the distinctive essential features and the achieved result:

- creating a hole in the projection of the douglas space in the parietal peritoneum, detached from the anterior wall of the rectum, provides the direct and shortest path to the pelvic cavity for the formed orthotopic neocystis without kinks and compression of its mesentery, which eliminates the likelihood of isotization of otrototopic neocystis. Moreover, the hole is created in the area of the peritoneum, exfoliated from the front wall of the rectum, which is not dissected. With carnal traction of the exfoliated section of the peritoneum from the front wall of the rectum, it is projected onto the area of the douglas space;

- hermetic closure of the peritoneum allows you to delimit the small pelvis from the organs of the abdominal cavity, that is, place the formed orthotopic neocystis in the small pelvis extraperitoneally, which restores the integrity of the peritoneum, since the organs of the abdominal cavity are in the initial physiological position, which reduces the risk of adhesions, the formation of different kind of "pockets", creating the likelihood of excesses, infringement of the intestinal loops and the occurrence of adhesive-intestinal obstruction.

The set of distinctive essential features is new and creates a direct and shortest path to the pelvic cavity for the formed orthotopic neocystis without kinks and compression of its mesentery, and also restores the integrity of the peritoneum, that is, it delimits the zones of the small pelvis and abdominal cavity, which, unlike the method prototype allows:

- maintain the physiological position of the abdominal organs;

- prevent ischemia of the formed orthotopic neocystis;

- exclude the possibility of the formation of various kinds of "pockets", creating the likelihood of excesses, infringement of the intestinal loops, which in turn eliminates the occurrence of adhesive-intestinal obstruction;

- to exclude the entry of urine into the abdominal cavity and thus prevent the development of urinary peritonitis and repeated surgical interventions with the possible failure of the ureterreservar anastomoses in case of urinary leakage.

The method is as follows.

A mid-skin incision is made, bordering the navel on the left. Open the anterior abdominal wall. The wound is bred with a retractor. On the right, and then on the left, the vas deferens is isolated, which is crossed and ligated at the clamps. In women, the uterine ligament is ligated and ligated. The ureters are isolated from the level of the intersection with the common iliac arteries distally to the bladder. 2 cm away from the bladder, they cross. The distal ends are ligated and, together with the bandaged proximal ends and the psilateral vas deferens, are clamped. Then the ureters mobilize proximal to the common iliac arteries. A ∩-shaped flap opens the peritoneum cranial to the top of the bladder, which is diverted downward. The peritoneum is excised anatomically and sparingly, only in the area of the apex of the bladder. At the same time, oncological principles are not violated - the peritoneum adjacent to the bladder is removed along with the bladder. Urachus is crossed at the navel, which is removed in a single block with the bladder. The abdominal organs are inspected to detect metastases or diseases that were not diagnosed during preoperative examination. Next, the side walls of the bladder are isolated. First, the superior cystic artery is first crossed and ligated, and then the lower and all tissues reaching the bladder from the lateral wall of the pelvis to the prostate gland. After that, the posterior surface of the bladder and prostate gland is isolated. The bladder is diverted anteriorly so that the peritoneum of the rectovesical pocket is visible. The last bordering the bladder is dissected. At the point of transition of the peritoneum from the bladder to the rectum, the peritoneum is dissected on the side of the bladder, preserving it for subsequent recovery. Then, with your fingers, the bladder, seminal vesicles and prostate gland with Denoneville aponeurosis easily peel from the rectum. The peritoneum is peeled off from the anterior wall of the rectum, and then its cranial traction is performed, and a hole is created in the parietal peritoneum in the projection of the douglas space in the area of the peritoneum that is exfoliated from the anterior wall of the rectum, which has not been dissected. After isolating the posterior and lateral walls of the bladder and prostate gland, they begin to isolate the anterior wall. The front wall of the bladder is separated from the pubic bones. The puboprostatic ligaments are identified and intersected closer to the pubic bones. Dissect the internal fascia of the pelvis. Fingers inserted into the incisions of the endopelvic fascia mobilize the lateral surfaces of the prostate to its apex. The dorsal venous complex is stitched, ligated, and transected. Directly at the tip of the prostate, the urethra is crossed. The bladder with the prostate and seminal vesicles does not fix anything, and the drug is removed. After removal of the bladder, a standard lymphadenectomy is performed. Then, retreating 25 cm from the ileocecal angle, isolate a segment of the ileum of 40 cm in length. The intestine is crossed between the clamps. The continuity of the intestinal tube is restored by an end-to-end anastomosis with a single-row nodal vicryl suture. The defect in the mesentery of the intestinal anastomosis is sutured. Then, the isolated iliac segment is laid S-shaped. The entire iliac segment is opened strictly along the mesenteric margin. The iliac plateau is sutured with a continuous 2-0 vicryl seam. Then, a dissector is inserted into the formed neocystis and a hole for the future anastomosis with urethra is created in its distal part. After that, the created neocystis through a small hole in the peritoneum in the projection of the Douglas space in the area of the peritoneum, exfoliated from the anterior wall of the rectum, which has remained uncut, is carried out into the pelvic cavity. The peritoneum in this place is fixed to the mesentery of neocystis. On the urethra, 6 vicrylic sutures are applied from the inside out. A transurethral Foley catheter, usually 22 F, with a polyvinyl chloride intubator is inserted into the cavity of the reservoir. Next, perform the urethroreservoir anastomosis. Vicryl sutures are placed on the urethra from the inside out. Thus, when tying the nodes of the anastomosis are outside the lumen of the reservoir and the urethra. Ureter implantation is performed after the reservoir has been moved to the pelvis and anastomosis with urethra has been performed. The ureters are implanted extraperitoneally, through a small incision in the wall of the created reservoir according to the method described by Camey and Le Duc [Le Duc A., Camey M., Teillac P. An original antireflux ureteroileal implantation technique: Long-term followup // J.Urol. - 1987. - Vol.137. - P.1156]. The implantation site is chosen so that the ureters lie without tension and excesses. The integrity of the peritoneum is restored by hermetic closure, and the abdominal cavity is delimited from the pelvis. The left ureter is intubated with a polyvinyl chloride intubator, and the right one with an ureteral stent. The ureteral stent is fixed to the intubator with a thread for simultaneous removal. The ureteral intubator, along with the Foley catheter draining the urinary reservoir, is removed through the urethra. Next, the front wall of the tank is sutured. After installing drainages in the pelvis, the wound is sutured in layers. The ureteral intubator, along with the stent, is usually removed on day 12. Urethral catheter for 14 days.

To illustrate the proposed method, we present Figure 1, explaining the anatomical features of the formation of holes in the parietal peritoneum. In Fig.1: 1 - the bladder, 2 - the rectum, 3 - the peritoneum adjacent to the bladder, 4 - the peritoneum adjacent to the front wall of the rectum.

The bladder (1) along its posterior wall and apex is covered with peritoneum. The peritoneum adjacent to the bladder (3) is dissected, and from the front wall of the rectum (2), the peritoneum adjacent to the front wall of the rectum (4) exfoliates.

The essence of the method is illustrated by a clinical example.

Example

Patient A., 59 years old, nos. And / b 28392 were hospitalized as planned on 08/10/2010 in the urology department of the city multidisciplinary hospital (GMPB No. 2 (S-Pb)) with complaints of blood in the urine, pain in the lower abdomen.

Upon admission, the patient's condition is satisfactory, clear consciousness, skin integument of usual color, peripheral lymph nodes are not enlarged, no edema. Hemodynamic parameters within normal limits, blood pressure 125/75 mm Hg On palpation - internal organs without features. Urination is free, urine is mixed with blood. In the clinic, the patient performed:

Electrocardiogram: sinus rhythm, heart rate 84 beats / min. Local disturbance of intraventricular conduction. Incomplete blockade of the right bundle branch block.

Fluorography - without pathological changes.

Computed tomography of the bladder: a bladder of sufficient volume, a pathological volume of 45 × 40 mm is visualized on the posterior and left lateral walls, the walls of the bladder in the base area are thickened. Lymph nodes of the pelvis are not changed.

Ultrasound examination: abdominal organs without pathology, no metastases. The kidneys are unchanged. The bladder contains 200 ml of urine; in the projection of the posterior wall and the left side wall, a hyperechoic tissue formation of 45 × 40 mm is visualized.

Cystoscopy: on the back and left walls, departing 2-2.5 cm from the neck of the bladder, a tumor formation is visualized on a wide base with a diameter of about 4.5 cm, protruding into the lumen of the bladder.

Blood test: Lake. - 7.0 × 10/9, erythr. - 4.0 × 10/12, hemoglobin - 125 g / l, platelets - 370 thousand, lymphocytes - 30, monocytes - 6, neutrophils - 54, stab - 1, eosinophils - 1, basophils - 0, ALT - 25 mmol / l, ACT - 23 mmol / l, total protein - 70 g / l, urea - 4.0 mmol / l, creatinine - 100 mmol / l, bilirubin total. - 7.0 μmol / L, glucose - 4.2 mmol / L, prothrombin - 90%.

Urinalysis: red, slightly turbid, specific gravity 1014, acid reaction, protein 0.012 g / l, white blood cells 8-10 in n / a, red blood cells 40-50 in n / a, flat epithelium 0-1-2 in n / sp., mucus ++. Urine cultures did not give rise.

TURT Bladder biopsy was performed on July 21, 2010. The histological conclusion No. 166476-06: "Moderately differentiated transitional cell carcinoma with invasion of the muscle layer." Given the presence of muscle-invasive cancer in the patient, the absence of severe somatic diseases, it was decided to perform a cystectomy with the formation of an orthotopic urinary reservoir with a segment of the ileum with an extraperitoneal location of neocystis.

On August 17, 2010, a mid-skin incision was made under endotracheal anesthesia and epidural anesthesia, bordering the navel on the left. The anterior abdominal wall is opened. The wound is diluted with a retractor. On the right, and then on the left, the vas deferens are highlighted, which are crossed and bandaged at the clamps. The ureters are isolated from the level of the intersection with the common iliac arteries distally to the bladder. 2 cm away from the bladder, they are crossed. Their distal ends are bandaged and together with the bandaged proximal ends of the ipsilateral vas deferens, are clamped. A ина-shaped flap revealed the peritoneum cranial to the top of the bladder, which is retracted downward. The peritoneum is dissected anatomically and sparingly, only in the area of the apex of the bladder. Next, the side walls of the bladder are highlighted. Positioning the left hand (when the right wall of the bladder is highlighted) so that the index finger is the medial of the internal iliac artery and behind the visceral branches extending from it to the bladder, the upper cystic artery is first crossed and ligated, and then the lower and all tissues that go to the bladder from the lateral wall of the pelvis to the prostate gland. After that, the posterior surface of the bladder and prostate was isolated. The bladder is retracted anteriorly so that the peritoneum of the rectovesical pocket is visible. The latter, bordering the bladder, is dissected. At the point of transition of the peritoneum from the bladder to the rectum, the peritoneum was dissected on the side of the bladder, preserving it for subsequent recovery. Further, the bladder, seminal vesicles and the prostate gland with Denoneville aponeurosis from the rectum were easily peeled off with fingers. The peritoneum is peeled off from the anterior wall of the rectum, and then its cranial traction is performed, and a hole is created in the parietal peritoneum in the projection of the douglas space in the area of the peritoneum that is exfoliated from the anterior wall of the rectum, which has not been dissected. The anterior wall of the bladder is separated from the pubic bones. Puboprostatic ligaments were identified and crossed closer to the pubic bones. Fingers inserted into the incisions of the endopelvic fascia mobilize the lateral surfaces of the prostate to its apex. The dorsal venous complex is stitched, ligated and crossed. Directly at the apex of the prostate, the urethra is cut off and the drug removed. 6 urethral sutures were placed on the urethra. After removal of the bladder, a standard lymphadenectomy was performed. Retreating 25 cm from the ileocecal angle, a 40 cm ileal segment was taken. Continuity of the intestinal tube was restored by an end-to-end anastomosis of serous-muscle single-row interrupted sutures (3-0 vicryl). The mesentery defect of the intestinal anastomosis is sutured. Then, the isolated iliac segment was laid S-shaped. The entire iliac segment is opened strictly along the mesenteric margin and a rounded reservoir is created from it, resembling a bladder in shape. Through the created hole with a diameter of 44 cm, a transplant was performed on the mesentery. The edge of the peritoneum was sutured to the mesentery. A Foley 22 F catheter was inserted transurethrally into the cavity of the reservoir along with a polyvinyl chloride intubator. A urethroreservoir anastomosis was performed. Next, implantation of the ureters is performed. The ureters are implanted from the inside through small incisions in the neoplasm wall according to the method described by Camey and Le Duc. The left ureter was intubated with a polyvinyl chloride tube; a stent was installed in the right ureter. The left ureter intubator is removed through the urethra along with the Foley catheter. Then, the remaining portion of the front wall of the neo-bubble was sutured with a continuous vikril seam. The integrity of the peritoneum is restored, and the abdominal cavity is delimited from the pelvis. In the small basin installed drainage. The wound is sutured in layers. In the postoperative period, antibiotic therapy, infusion and detoxification therapy were carried out. The postoperative period was uneventful, the ureteric intubators and stent were removed on the 12th day, the urethral catheter on the 14th. Independent urination was restored, the patient did not notice any urine leakage, he got up at night after 2 hours. After the operation, intravenous urography was performed: renal function is satisfactory, the abdominal cavity systems and ureters are not expanded (Figure 1).

According to the results of descending cystography, a reservoir of 250 ml. When mixing cystography data for vesicoureteral reflux was not obtained. Blood test: white blood cells - 7.2 * 10/9, red blood cells - 4.0 * 10/12, hemoglobin 120 g / l, platelets 250 thousand, lymphocytes 29, monocytes 06, neutrophils 60, p / 2, s / nuclear 40, eosinophils 1, basophils 1, ALT 19 mmol / L, ACT 30 mmol / L, total protein 70 g / L, creatinine 110 μmol / L, glucose 4.4 mmol / L.

Urinalysis: light yellow, cloudy, beats. weight 1018, neutral reaction, protein 0.015, white blood cells 10-12 in n / a., squamous epithelium 0-1 in n / a, mucus ++.

09/10/2010, the patient in satisfactory condition was discharged under the supervision of an oncourologist at the place of residence. Dynamic observation is recommended, taking uroseptics. Control examination after 1 month.

During the control examination 1 month after surgery, the patient's condition is satisfactory. Urinary incontinence is not noted. Renal function is satisfactory, pyelocaliceal systems are not expanded. The bladder on the cystogram is rounded, there is no vesicoureteral reflux. The volume of the tank is 350 ml. With uroflowmetry, the maximum urination rate is 20 ml / s, the average is 15.7. With cystometry, intravesical pressure at the first urge to urinate is 18 cm of water. century, and the maximum - 37 cm water column The patient does not note day and night enuresis. The frequency of urination in the daytime does not exceed 7 times, at night it rises to urinate no more than 2 times.

The method was developed in the Department of Urology of the city multidisciplinary hospital No. 2 of St. Petersburg and has passed clinical testing. To date, the proposed method performed 5 cystectomy in men for bladder cancer.

The inventive method for the surgical treatment of bladder cancer creates a direct and shortest path to the pelvic cavity for the formed orthotopic neocystis without kinks and compression of its mesentery, and also restores the integrity of the peritoneum, that is, it delimits the zones of the small pelvis and abdominal cavity, which, unlike the method prototype allows:

- maintain the physiological position of the abdominal organs;

- prevent ischemia of the formed orthotopic neocystis;

- exclude the possibility of the formation of various kinds of "pockets" that create the likelihood of excesses, infringement of the intestinal loops and, as a result, prevent the occurrence of adhesive-intestinal obstruction;

- to exclude the entry of urine into the abdominal cavity and thus prevent the development of urinary peritonitis and repeated surgical interventions with the possible failure of the ureterreservar anastomoses in case of urinary leakage.

Claims (1)

A method of orthotopic cystoplasty, including radical cystectomy with the subsequent formation of orthotopic neocystis from the ileum segment, implantation into the formed orthotopic neocystis of the ureters, characterized in that the peritoneum is dissected at the site of transition from the bladder to the rectum, the peritoneum is peeled from the front wall of the rectum cranial traction, in the projection of the douglas space create a hole in the parietal peritoneum, exfoliated from the front wall of the rectum, conducting t through the created hole formed orthotopic neocystis into the pelvic cavity, after implantation of the ureters, the peritoneum is hermetically sutured.

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