["T antireflux mechanism" Ileal neobladder].

During the past 15 years, orthotopic urinary diversion surgery has evolved from "experimental"to become the standard treatment in higher volume and experience world centers as the preferred method of urinary diversion in both sexes. The overall complication rate of the intussuscepted afferent segment required for the construction of a continent Koch reservoir, led to the late 90's development and description by Skinner et al. of the continence and anti-reflux "T- mechanism". Based on the subserosal appendix-tunneling described by Mitrofanoff and the extraserosal ureteric-tunnelling by Ghoneim, this new mechanism has been used successfully incorporated into an orthotopic diversion system ("T-neobladder or T-pouch"). Apparently, this "T-mechanism"has eliminated the problems associated with the intussuscepted intestinal segment, while maintaining an effective anti-reflux and continence system. This article describes in detail the surgical steps for the construction of an ileal T-neobladder.