Studer Orthotopic Neobladder: A Modified Surgical Technique

OBJECTIVE: A modified technique for orthotopic ileal neobladder preparation is described. The Studer technique is the method most frequently used worldwide and seems to be an ideal reconstructive solution after radical cystectomy. METHODS: After radical cystectomy, urinary diversion is attained by means of a detubulized ileal segment. About 40 cm are used to create the reservoir and 15 cm for a tubular afferent limb. A spheroidal-shaped reservoir is then obtained with a conic distal part that will be anastomized to the urethral stump. After the reconstructive part, the neobladder and the afferent limb are attached to the levator ani and psoas muscles respectively. Post-operative results on a series of 36 patients are reported. RESULTS: The final shape of the reservoir was roughly spherical. A small amount of anastomotic strictures was registered. Renal function was not impaired after surgery, even at late follow-up. CONCLUSION: Even if the Studer technique is already well described, we believe that our technical changes may improve urinary tract restoration, and potentially decrease complications typical of urinary orthotopic diversion. Further cases are required to confirm possible advantages of the modified technique.