Cistoplastia de aumento com recurso a neobexiga ileal ortotópica ‐ técnica de Studer modificada

Abstract

Although exceedingly rare in developed countries nowadays, we still come across some devastating sequels of genitourinary tuberculosis, requiring careful medical evaluation and expertise on surgical reconstruction. A 58‐year‐old man, previously submitted to a right nephrectomy, developed a life‐threatening episode of urosepsis, leading to the need of a percutaneous nephrostomy due to a long stricture of the terminal ureter of the remaining left kidney. The patient had also developed very severe urinary frequency related to an extremely crippled bladder, with a capacity under 20 mL. After medical treatment of the tuberculosis, an augmentation cystoplasty was performed but in a patient‐tailored way, using an ileal neobladder constructed following the Studer technique that was anastomosed to the remaining bladder tissue with implantation of the healthy segment of the shortened ureter on the afferent limb of the reservoir. The normalisation of bladder capacity (over 250 mL), with preserved filling sensation allowed an excellent patient adaptation. The combination of a severely decreased bladder capacity with a stenosis of the terminal ureter of a single kidney led to a need of a great capacity reservoir as well as a reimplantation of a shortened ureter. The use of an orthotopic ileal neobladder as a large ileocystoplasty patch was the solution adopted.