The S-bladder, an ileal bladder substitution.

Abstract

Low pressure continent urinary diversions with abdominal wall stomas alike the Kock-pouch have shown good results. However, if urethral function can be saved without risk, an anastomosis of a bowel bladder to the urethral stump is more favorable in regards of continence, ease of the procedure and cosmetics. The S-bladder developed on the basis of the S-pouch from Parks, is conceptualized to be a complete replacement of the lower urinary tract, offering a low pressure reservoir, safe antireflux mechanisms, continence and voiding per urethra with abdominal straining. 52 patients (46 males and 6 females) were treated with an S-bladder. Continence in daytime and nighttime was achieved in 44 patients, while 49 patients remain continent during the day. To achieve this result 16 of our patients had to be treated with an artificial sphincter implanted at the bulbous urethra. Eleven of these 16 patients suffered from neurogenic bladder disease with preoperative urethral incompetence. Indications was TCC of the bladder in 38, neurogenic bladders in 11 and low-compliance bladders in 3 patients. The complication rate of 13.5% was acceptable. Emptying by abdominal straining was possible in all patients. Residuals were less than 50 cc, even in those patients with artificial sphincters.