SPONTANEOUS LATE RUPTURE OF ORTHOTOPIC DETUBULARIZED ILEAL NEOBLADDERS: REPORT OF FIVE CASES JOHANNES B. W. NIPPGEN, OLIVER W. HAKENBERG, ANDREAS MANSECK, AND MANFRED P. WIRTH ABSTRACT Objectives. To report five spontaneous ruptures in 4 patients. Spontaneous late rupture of orthotopic ileal bladder replacements is a rare complication of continent urinary diversion. Methods. Four recurrence-free patients aged 36 to 68 years experienced apparently spontaneous rupture of continent orthotopic ileal bladder replacement 3 months to 3 years after curative radical cystectomy and urinary diversion for invasive bladder cancer. Ileal bladder rupture occurred twice in 1 patient with an interval of 9 months. Results. All 4 patients had had a good result from their diversion procedure and had reported complete day and nighttime continence before the spontaneous rupture. The spontaneous rupture was evidently caused by overdistension of the ileal neobladder in four of five instances. In addition to overdistension, a second factor such as minor blunt abdominal trauma or urethral occlusion was identifiable in two instances. The rupture occurred in the right upper corner of the ileal bladder in four of five instances and led to acute and severe abdominal pain. Cystography was done in three instances, but was diagnostic in only 2 cases. The histologic examination of the excised bladder wall margins revealed nonspecific inflammatory changes in 3 cases. Open surgical drainage and repair was successfully undertaken in all cases. Conclusions. The circumstances of the cases described suggest that late spontaneous rupture of an ortho- topic ileal bladder replacement is not related to the surgical technique but rather to factors of patient compliance and medical management. UROLOGY 58: 43–46, 2001. © 2001, Elsevier Science Inc. O rthotopic bladder replacement using detubu- larized ileum has become a very common form of continent urinary diversion in men after radical cystectomy for bladder cancer. 1 This form of urinary diversion allows high-capacity urine storage, voiding by way of the urethra using ab- dominal pressure, and a high degree of day and nighttime continence in most patients, without the need for additional catheterization. For these reasons and because the medium and long-term functional results so far reported have been good, continent ileal bladder replacement techniques have become very popular with both patients and urologic surgeons. 2,3 Of the complications reported for bladder re- placements of this type, 3 spontaneous late ruptures are very rare. After the immediate postoperative period, urinary leakage from ileal bladder replace- ments should not occur. Secondary urine extrava- sation will lead to peritonitis and usually to acute abdominal pain. MATERIAL AND METHODS We report five instances of late rupture of an ileal bladder replacement in 4 recurrence-free men following continent di- version after radical cystectomy for bladder cancer. All the patients were treated at our institution between January 1995 and June 1999. Patient age ranged from 36 to 68 years. All 4 patients had undergone radical cystoprostatectomy for muscle-invasive urothelial carcinoma of the bladder with pathologically com- plete resection (R0) and negative lymph nodes. For urinary diversion, a continent detubularized ileal bladder replace- ment, the ileal neobladder as described by Hautmann and as- sociates, 4 had been done with ureteral implantation using ei- ther the technique described by Le Duc 5 or Abol-Eneim. 6 All 4 patients had had uneventful and uncomplicated immediate From the Department of Urology, University Hospital Carl- Gustav Carus, Technical University, Dresden, Germany Reprint requests: Oliver W. Hakenberg, M.D., Klinik fu ¨r Urologie, Universita ¨ ts-Klinikum Carl-Gustav Carus, Fetscher- strasse 74, D-01307 Dresden, Germany Submitted: November 2, 2000, accepted (with revisions): Feb- ruary 12, 2001 ADULT UROLOGY © 2001, ELSEVIER SCIENCE INC. 0090-4295/01/$20.00 ALL RIGHTS RESERVED PII S0090-4295(01)00995-5 43