Male, 63 years old. He consulted for monosymptomatic macroscopic haematuria. An ultrasound scan was requested, showing a 5 cm mass on the left lateral aspect of the bladder that produced ureterohydronephrosis in the left kidney. A TUR-biopsy was performed, revealing a high-grade infiltrating bladder tumour. The extension study was negative. The patient's creatinine was 2.5 mg/dl. A laparoscopic radical cystoprostatectomy with Bricker-type urinary diversion was performed in March 2005 (high-grade pT2b No Mo, affecting the trigonal area and posterior aspect).
The operative course evolved favourably. In the postoperative review one month after surgery, the left ureterohydronephrosis was reduced while maintaining a certain degree of cortical atrophy, and renal function improved (creatinine of 1.65 mg/dl).

The patient presented very poor tolerance to the stoma, insisting on its conversion to a continent shunt. This situation was considered due to the improvement in his renal function. Two months later we performed an exploratory laparotomy, achieving a good pelvic dissection and identification of the urethral stump. We constructed an ileal neobladder with 45 cm of ileum. Surgical time was 180 minutes, with bleeding of less than 80 cc. The patient was discharged on the sixth postoperative day without complications.
Five months after surgery, he is continent during the day and night, with good emptying of the reservoir.
Both patients were thoroughly informed of the risks of surgery and its possible complications, as well as the potential sequelae in terms of metabolic disorders, persistent diarrhoea and incontinence and/or the need for self-catheterisation due to high post-micturition residual. In both cases, the Bricker loop was released from the abdominal wall and after shortening it was anastomosed to the neobladder chimney, requiring no ureteral reimplantation. The bladder catheter was removed after 3 weeks and both patients achieved continence in a short period of time. Both patients are very satisfied with the orthotopic shunt.

