ABSTRACT
Bladder substitution with bowel segments following total cystectomy is an accepted procedure. A variety of bowel segments and configurations have been described for orthotopic bladder replacement following total cystectomy. This chapter details the use of the detubularized left colon for total bladder replacement (neobladder) in both men and women. Left colon neobladder (sigmoid neobladder) closely mimics the native bladder functionally. It provides an adequate lowpressure reservoir for storage and expulsion of urine under voluntary control. Antireflux ureteral implantation is possible and electrolyte imbalances are minimal.
The most common indication to perform total bladder replacement is following radical cystectomy for locally invasive bladder cancer. Ideal candidates are those whose primary bladder cancer is located away from the bladder neck. The presence or extension of the tumor close to the bladder neck and/or multifocal carcinoma in situ of the bladder is a relative contraindication in men. Transitional cell carcinoma of the prostatic urethra or tumor at the distal urethral margin is an absolute contraindication. In women the presence of tumor at the bladder neck is a contraindication for total bladder replacement. Other indications include a crippled bladder or interstitial cystitis especially in women.
