The Hautmann neobladder with a chimney: a versatile modification.

Abstract

We describe a modification to the popular Hautmann ileal neobladder comprised of a chimney for the ureterointestinal anastomosis in order to enhance its flexibility, reduce its pitfalls and hence make more patients candidates for this type of diversion. The Hautmann ileal neobladder is prepared in the standard fashion except that an additional 5 to 10 cm. (or more if needed in the case of a short ureter) of small bowel are selected to be added for either a left or right "chimney" (depending on which side the ureter may be shorter or if there is a solitary kidney). The V segment of the W which will be anastomosed to the urethra is made longer than the contralateral V segment. A neobladder neck is created by sewing together the cut edges of a 5 cm. lip in the lowermost W configuration of the neobladder, allowing an end-to-end urethrointestinal anastomosis. Between March and October 1996, 3 patients have undergone this procedure at the University of Virginia. Two had right chimneys and 1 had a left chimney. Followup is short, but there have been no complications except for a transient postoperative partial small bowel obstruction in 1 patient. Two patients have no urinary incontinence, the third has only occasional nocturnal incontinence. This modification of the Hautmann ileal neobladder provides greater versatility for short ureters, minimizes tension from the mesentery on the urethrointestinal anastomosis, simplifies the ureterointestinal anastomosis and provides easy postoperative access for ureterointestinal anastomosis revision or resection in case of recurrent disease.