The Orthotopic Neobladder: Does the Length of the Isoperistaltic Limb Matter?

Several techniques for neobladder reconstruction were described. The uretero-enteric anastomosis is a very critical step, if improperly done it puts the upper urinary tract at risk. The application of anti-reflux technique is debated [2]. The use of an isoperistaltic limb (chimney) for uretero-enteric anastomosis is a well-known technique to overcome reflux and other difficulties as short ureters, short intestinal mesentery and short urethral stump [3]. However, the length of the isoperistaltic limb is a matter of controversy. Originally, Studer et al. stated that a 20 cm isoperistaltic ileal segment can prevent reflux by transmission of the intraabdominal pressure on this afferent segment during voiding using Valsalva maneuver [4]. However, during his first 20 years of experience, he minimized this length to 14 cm to 16 cm [5]. Moreover, Hautmann modified his original technique and performed the anastomosis of the ureters to a short isoperistaltic limbs about 3 cm to 5 cm in a freely refluxing end to end manner instead of Le Duc anti-reflux procedure. This decreased the incidence of stenosis from 9.5% to only 1% [6].