Creation of an ileocolic bladder after cystectomy.

A divided segment of ileum and colon is used to create a neobladder after cystectomy with a cecourethral anastomosis to provide volitional voiding with continence. Such a bladder provides for good sensation with a large low pressure reservoir and an antireflux ureteral anastomosis. The standard nerve-sparing cystoprostatectomy is performed and no segment of the bladder or prostate is left to compromise the cancer operation. In female or male patients with diffuse carcinoma in situ a similar reservoir with a plicated ileocutaneous anastomosis also can provide continence with intermittent catheterization. Four patients with a urethral anastomosis have day and nighttime continence, and 2 with a cutaneous stoma have 4 to 5-hour dry intervals. Ultimately, it is possible for a patient to void with good urinary control and to have sexual function after cystectomy.