RU-2861519-C1 - METHOD FOR CREATING ORTHOTOPIC SMALL-INTESTINAL NEOCYSTIS AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER

RU2861519C1RU 2861519 C1RU2861519 C1RU 2861519C1RU-2861519-C1

Abstract

FIELD: medicine. SUBSTANCE: invention relates to urology, oncology, and can be used for restoring urinary function after radical cystectomy. A fragment 40-50 cm long on the mesentery is resected from the ileum at a distance of 20 cm from the ileocaecal angle. After restoring the integrity of the intestine, the graft is detubularised, folded in a U-shape, and sutured with a single-row suture along the posterior surface. Submucosal tunnels 1 cm long are formed in the posterior wall of the created reservoir, through which the distal ends of the ureters with a preserved vascular pedicle are passed. Neocystoureteroanastomoses are formed using the Le Duc anti-reflux technique. The anterior wall of the neocystis is sutured, leaving an opening 10 mm in diameter in the lower part, the edge of the mucosa of which is everted with four sutures. A neocystourethral anastomosis is formed by connecting the edges of the urethra and neocystis with six ligatures at 2, 4, 6, 8, 10, and 12 o'clock without tension. The operation is completed by fixing the neocystis to the parietal peritoneum and pelvic walls with five interrupted sutures on each side. EFFECT: possibility of using short segments of the ureters and mesentery, reducing the risk of ischemia and anastomotic leakage, shortening the operation time and hospitalisation period to 13-14 days, providing reliable blood supply to the graft, creating a low-pressure reservoir with an effective anti-reflux mechanism and stable fixation in the pelvis due to the absence of mesentery inversion, use of the Le Duc tunnel technique, and fixation of the neocystis to the pelvic walls. 1 cl, 5 dwg, 3 ex

Inventors

Islamov Rashit Gabbasovich
Gataullin Ilgiz Gabdullovich
Nasrullaev Marat Magomedovich
Islamov Karim Rashitovich
Gataullin Bulat Ilgizovich
Galiev Ilnaz Ilkhamovich

Dates

Publication Date: 20260505
Application Date: 20251002

Claims (11)

A method for creating an orthotopic small intestinal neobladder after radical cystectomy for bladder cancer, characterized by the fact that at a distance of 20 cm from the ileocecal angle in the proximal direction, a resection of a fragment of the ileum 40–50 cm long with its mesentery is performed, obtaining an intestinal transplant with a mesentery, the integrity of the ileum is restored using a single-layer end-to-end anastomosis, and the opening in the mesentery is sutured;
the resulting intestinal transplant is detubulated and folded in the shape of the letter "U" in the longitudinal direction, a single-row suture is applied to the posterior surface in the longitudinal direction,
two holes are cut out on the posterior surface, positioning them in height depending on the location of the distal ends of the ureters with the preserved vascular pedicle; a submucosal tunnel 1 cm long is formed through these holes,
then, in the walls of the distal ends of the ureters with the preserved vascular pedicle, a 5 mm long incision is made in the longitudinal direction, the said cut distal ends of the ureters are inserted together with the ureteral catheters installed in them into the said submucosal tunnel,
neocystoureteroanastomoses are formed on both sides using the Le Duc antireflux technique between the ends of the dissected ureters and the neocyst being created from the side of its mucous membrane using 4-5 single-row interrupted sutures on each side,
the anterior wall of the created neobladder is sutured with a continuous suture so that a neobladder opening with a diameter of 10 mm remains in its lower anterior part,
four sutures are placed on the opening of the neobladder, with the help of which the edge of the neobladder mucosa is turned inside out,
six ligatures are applied around the perimeter of the urethra at 2; 4; 6; 8; 10 and 12 o'clock on a conventional clock face, leaving the ends of the ligatures,
a Foley catheter is inserted into the opening of the neobladder through the urethra, and ureteral catheters are brought out in the opposite direction,
the ends of six ligatures placed along the perimeter of the urethra are placed along the perimeter of the everted edge of the mucous membrane of the neobladder opening at 2; 4; 6; 8; 10 and 12 o'clock positions on a conventional clock face and tied, thereby connecting the openings of the urethra and neobladder, while forming a neocystourethral anastomosis without tension,
The neobladder is fixed circularly to the preserved parietal peritoneum and pelvic walls with five interrupted sutures on each side.

Description

The invention pertains to medicine, specifically urology. It is used to create artificial neobladders (urinary reservoirs) after bladder removal, enabling the most physiological replacement of bladder function. Below, the applicant provides the terms and definitions used in the claimed description. Anastomosis is a connection, especially between vessels, hollow organs, and cavities that are normally separated from each other or branch. Detubularization is a surgical procedure that involves incising a segment of the ileum along the antimesenteric border. This allows for the creation of a neobladder with low intraluminal pressure due to its larger diameter, capacity, and the absence of coordinated contractions of the intestinal wall. Ileocystoplasty is a method of plastic surgery (replacement) of the urinary bladder with a reconstructed section of the ileum. Ischemia is a pathological condition caused by insufficient blood supply to organ tissues. A Foley catheter is a device that is a tube with an inflatable element that ensures the outflow of urine. An intestinal graft is a segment of the ileum used in bladder reconstruction to create an orthotopic small bowel neobladder. A urinary fistula is an artificial tract that results in the abnormal diversion of urine. Depending on the diversion cavity, a fistula can be classified as external (the distal opening of the fistula opens onto the skin) or internal (the diversion occurs within a body cavity). A ureteral catheter is a tube inserted into the ureter to drain urine temporarily or long-term. A neobladder is a urinary reservoir created to collect urine from a portion of the ileum – an intestinal graft. Anastomotic failure is a disruption of the integrity of surgical sutures and the continuity of a hollow organ (intestine, stomach, bladder), resulting in leakage of contents into the abdominal cavity and pelvis. Orthotopic plastic surgery/reconstruction is the formation of a neobladder, which involves its placement in the pelvic cavity at the site of the removed bladder, and the creation of a reservoir-urethral anastomosis (connection between the neobladder and the urethra). Radical cystectomy is the complete removal of the bladder and adjacent lymph nodes (lymph node dissection). In men, radical cystectomy includes en bloc removal of the bladder, a portion of the visceral peritoneum and paravesical tissue, the prostate gland, and the seminal vesicles; and pelvic (ilio-obturator) lymph node dissection. In women, radical cystectomy involves removal of the bladder, a portion of the visceral peritoneum and paravesical tissue, removal of the uterus and appendages, and resection of the anterior vaginal wall. A high-pressure neobladder is a segment of the ileum used in bladder plastic surgery that creates high pressure inside the ileum, which increases the incidence of retrograde reflux. Stenosis is a narrowing of a vessel, duct, channel, hollow organ or its opening, leading to a partial or complete obstruction of their patency. Stricture is a persistent narrowing of the lumen of any hollow anatomical structure of the body. Radical cystectomy is traditionally considered one of the most disabling surgical procedures, associated with a high rate of intraoperative and postoperative mortality, a significant risk of severe complications in the postoperative period, and an unfavorable long-term prognosis for patient survival and/or disability. According to WHO statistics, the 5-year survival rate after surgery is 50%. The addition of preoperative chemotherapy slightly improves survival (up to 8%). These unfavorable indicators are explained by both the technical limitations of the surgical techniques used, characteristic of the early stages of radical cystectomy development, and the insufficient effectiveness of the approaches to postoperative urinary diversion that existed at the time of application. However, the introduction of modern surgical technologies and improved ileocystoplasty techniques has fundamentally changed the approach to radical cystectomy, facilitating its wider use and significantly improving treatment outcomes. As of the date of submission of the application materials, orthotopic bladder reconstruction is considered the gold standard in bladder cancer surgery for patients without obvious contraindications to this procedure. Ileal segments are most commonly used to create an orthotopic neobladder due to their anatomical accessibility, sufficient length, and functional characteristics. Patent and scientific medical literature contain numerous descriptions of various bladder replacement techniques after radical cystectomy, reflecting the active development and improvement of this field of surgery. This diversity of approaches allows specialists to individualize the choice of reconstruction method, optimally adapting it to the anatomical and functional characteristics of each patient. An invention is known under patent RU No. 2279254 "Method of orthotopic int