Ileal Neobladder Substitution (ileal bladder) (4 of 9)

The most commonly used bowel segments for continent urinary diversion are either ileum or a combination of terminal ileum and ascending colon. Ensuring that all continent diversions store and empty urine at low pressures is paramount. High storage and voiding pressures ultimately cause high-pressure reflux nephropathy and may result in renal failure; therefore, all bowel segments used for continent diversion, with the exception of their use in a ureterosigmoidostomy procedure, initially are detubularized. The bowel segments then are refashioned in a more spherical shape, which increases capacity and decreases luminal pressure by a magnitude of 3- to 4-times lower than the original segmental pressure.