[Orthotopic replacement of the bladder].

The Davis technique has been used in 42 male patients with invasive bladder cancer, node-negative, and no bladder neck or prostatic involvement with TCC. Patients were told before the operation that there might be occasional difficulties with voiding and nocturnal incontinence, and that catheterisation might sometimes be necessary. All had undergone cysto-prostatectomy and bilateral pelvic lymphadenectomy. A 40 cm segment of ileum with the most dependent mesentery was used to make the urethro-ileal anastomosis. It was placed in a U-shaped configuration and the back wall closed with absorbable staples. Using electro-cautery, the segment was opened to gain access to the anterior staples, which were then removed. The segment was then folded up to form a conventional Kock pouch, with two corners. Finally the anterior portion was closed with absorbable staples or sutures. After three months approximately 95% of patients remained dry during the daytime and 75% at night. A total of 90% of patients were highly satisfied with the outcome, dissatisfaction relating mainly to incontinence and the need to catheterize.