The Le Bag Orthotopic Urinary Diversion

No AccessJournal of UrologyClinical Urology: Original Article1 Sep 1996The Le Bag Orthotopic Urinary Diversion Peter N. Kolettis, Eric A. Klein, Andrew C. Novick, J. Christian Winters, and Rodney A. Appell Peter N. KolettisPeter N. Kolettis , Eric A. KleinEric A. Klein , Andrew C. NovickAndrew C. Novick , J. Christian WintersJ. Christian Winters , and Rodney A. AppellRodney A. Appell View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)65664-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We reviewed our experience with Le Bag orthotopic urinary diversion in 38 cases. Materials and Methods: Between April 1990 and January 1995, 38 men underwent radical cystectomy and Le Bag urinary diversion for treatment of bladder cancer. Approximately 20 cm. each of detubularized ileum and cecum were used to construct the pouch. A total of 22 pouches was fashioned with absorbable staples. In 21 cases freely refluxing Bricker ureterointestinal anastomoses were used. Results: There was no significant difference in major complication rates in the hand sewn versus stapled anastomosis groups, and there were no complications specifically related to the use of staples. There were 3 episodes of febrile urinary tract infection: 2 in the Bricker group and 1 in the tunneled anastomosis group. There was no significant difference between the 2 groups with respect to ureteral obstruction. The daytime continence rate was 91 percent, and 80 percent of the patients are completely dry or have only mild incontinence at night. Most patients had mild hyperchloremic metabolic acidosis postoperatively as evidenced by a decrease in median serum bicarbonate level (28 versus 24 mmol./l.). This difference appears to be related to pouch length (r = 0.58, p = 0.0002). Conclusions: We conclude that the Le Bag technique is a technically feasible form of urinary diversion with functional results similar to other forms of orthotopic diversion. Use of absorbable staples simplifies pouch construction without increasing complications. This form of urinary diversion is associated with hyperchloremic metabolic acidosis, which is related to pouch length. References 1 : Options in replacement cystoplasty following radical cystectomy: high hopes or successful reality. J. Urol.1995; 153: 1363. Link, Google Scholar 2 : Selection of intestinal segments for bladder substitution: physical and physiological characteristics. J. Urol.1988; 139: 519. Link, Google Scholar 3 : Le Bag: total replacement of the bladder using an ileocolonic pouch. J. Urol.1986; 136: 27. Link, Google Scholar 4 : Radical cystectomy. In: . Baltimore: Williams and Wilkin1989: 492. chapt. 46. Google Scholar 5 : Early continence after radical prostatectomy. J. Urol.1992; 148: 92. Link, Google Scholar 6 : An original antireflux ureteroileal implantation technique: long-term followup. J. Urol.1987; 137: 1156. Link, Google Scholar 7 : Rapid construction of right colon pouch: initial clinical experience. Urology1994; 43: 228. Google Scholar 8 Rowland, R. G., Kaefer, M. and Hollensbe, D. W.: Technique of the Indiana stapled neobladder. AUA North Central Section abstract, 1993. Google Scholar 9 : The sensitivity of pressure specific bladder volume versus total bladder capacity as a measure of bladder storage dysfunction. J. Urol.1994; 152: 1578. Link, Google Scholar 10 : Results, complications and surgical indications of the Florida pouch. Surg., Gynec. & Obst.1991; 173: 289. Google Scholar 11 : Renal scarring and bacteriuria 9-16 years after urinary diversion with and without antirefluxing anastomosis. J. Urol., part 21995; 153: 302A. abstract 296. Google Scholar 12 : Functional and urodynamic characteristics of an ileal neobladder. J. Urol.1993; 149: 1072. Link, Google Scholar 13 : Stanford pouch ileal neobladder: clinical, radiologic, and urodynamic follow-up. Urology1993; 41: 517. Google Scholar 14 : Simple ileal substitute bladder after radical cystectomy: experience with modification of the Studer pouch. J. Urol.1995; 153: 1432. Abstract, Google Scholar 15 : Continence following Le Bag. J. Urol., part 21988; 139: 335A. abstract 689. Google Scholar 16 : 100 Cases of Mainz pouch: continuing experience and evolution. J. Urol.1988; 140: 283. Link, Google Scholar 17 : Experience in 100 patients with an ileal low pressure bladder substitute combined with an afferent tubular isoperistaltic segment. J. Urol.1995; 154: 49. Link, Google Scholar 18 : Continence mechanisms following orthotopic bladder substitution. Scand. J. Urol. Nephrol.1992; 142: 95. Google Scholar 19 : Urodynamic comparison of ileum vs. sigmoid in augmentation cystoplasty for neurogenic bladder dysfunction. Neurourol. Urodynam.1995; 14: 231. Google Scholar 20 : Cystourethrometric findings in patients with detubularized right colonic segment for bladder replacement. J. Urol.1991; 145: 538. Link, Google Scholar From the Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio.© 1996 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited bySagalowsky A and Frenkel E (2018) Cobalamin Profiles In Patients After Urinary DiversionJournal of Urology, VOL. 167, NO. 4, (1696-1700), Online publication date: 1-Apr-2002.KIM H and STEINBERG G (2018) THE CURRENT STATUS OF BLADDER PRESERVATION IN THE TREATMENT OF MUSCLE INVASIVE BLADDER CANCERJournal of Urology, VOL. 164, NO. 3 Part 1, (627-632), Online publication date: 1-Sep-2000. Volume 156Issue 3September 1996Page: 926-930 Advertisement Copyright & Permissions© 1996 by American Urological Association, Inc.Metrics Author Information Peter N. Kolettis More articles by this author Eric A. Klein More articles by this author Andrew C. Novick More articles by this author J. Christian Winters More articles by this author Rodney A. Appell More articles by this author Expand All Advertisement PDF downloadLoading ...