Application of the transmesenteric serosal tunnel ureteral anastomosis technique in neobladder
Objective:To explore the clinical application of the transmesenteric serosal tunnel ureteral anasto-mosis technique in sigmoid neobladder.Methods:This study included 46 patients who underwent standard radical cystectomy and in situ urinary diversion through the sigmoid colon from Jan.2016 to Jan.2020 at Second Affilia-ted Hospital of Kunming Medical University.A 25 cm segment of the sigmoid colon was used to create a urinary reservoir.Punctures were made at the mesenteric edges of both sides of the reservoir,and the ureters were dragged through the subserosal layer of the mesentery into the bladder for about 1.5 cm,then fixed to the bladder mucosa using 4-0 absorbable sutures with 4 to 6 interrupted stitches.The ureteral ends were trimmed,and a 6 to 8F stent was placed inside the ureter.The upper edge of the ureteral end was incised,and the incised ureter was unfolded downwards to form a fan shape,which was then sutured to the posterior wall mucosa of the reservoir at the apex of the fan shape with two stitches using 4-0 absorbable sutures.Results:The operation time was 200-300 min,with a blood loss of 300-725 mL.The average hospital stay was(22.6±6.1)days,with no intraopera-tive or perioperative deaths.The follow-up period ranged from 4 to 59 months,averaging 34 months.During the 3-month postoperative long-term follow-up,3 patients developed unilateral hydronephrosis,and ureteral-neoblad-der anastomotic stricture was discovered through ureteroscopy.There were no cases of ureteral reflux.The day-time continence rate was 81.1％,and the nighttime continence rate was 55.9％.Four patients had residual urine volume exceeding 50 mL.The maximum neobladder capacity was(410±60)mL.Conclusion:The transmesenter-ic serosal tunnel ureteral anastomosis technique is simple and reliable,achieving antireflux effects while ensuring a low incidence of ureteral stricture.
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