Ces Urol 2006, 10(1):23-26 | DOI: 10.48095/cccu2006006

Heterotopic neobladder - Hadera pouch

K. Mainer¹, J. Krhut¹, J. Kopecký¹, Z. Háring 1
kresba: D. Matura²

¹ Urologické oddělení FNsP Ostrava

² Gynekologická klinika FNsP Ostrava

Objective: At present, we are witnessing a boom in reconstructive urology. Urinary diversion is indicated not only in patients with locally advanced bladder malignancy but also in patients who have failed conservative management of lower urinary tract dysfunctions. Heterotopic neobladder is an ideal solution for patients who are not suitable candidates for orthotopic bladder replacement. A major challenge in heterotopic neobladders is the creation of the continent mechanism. The authors reviewed their experience with a heterotopic pouch which was described by professor Yachia from Hadera town (Israel) and named after his hometown.

Material and methods: Hadera continent reservoir is created from the colocaecal segment. The efferent limb of the pouch is the native appendix which passes through three crossed strips of the right rectal muscle strands and is anastomosed to the umbilicus. Between the years 2001 and 2005, a total of 12 patients (three men and nine women) aged 15-70 (mean age 39) underwent continent heterotopic diversion. The indications for bladder replacement included bladder cancer in three patients, painful bladder in four and neuropathic bladder in five patients (meningomyelocoele thrice and posttraumatic spinal lesion twice).

Results: At a mean followup of 16.7 months (range 14 to 36), ten patients were completely dry during the day and night. Two patients were incontinent, one performed occlusion of stoma during the night and another one achieved continence when recieving anticholinergic medication. Functional capacity of the neobladder is between 250-700mis. Self-catheterisation is performed four to eight times a day. Acute pyelonephritis developed in two patients postoperatively. One patient experienced trouble passing the catheter early postoperatively. One patient had to undergo conversion to ceacal conduit due to permanent pain in the abdominal area preventing self-catheterisation of the continent neobladder.

Conclusion: Hadera pouch is an excellent type of continent heterotopic neobladder. The appendix or ileal segment are passed through the rectal muscle whose non-detached strips are crossed over them. Continence mechanism depends on circumferential external compression to the efferent limb as a natural sphincter.

Keywords: heterotopic neobladder, appendicostomy, continence

Published: January 1, 2006