A 63-year-old man.
She presented with macroscopic monosymptomatic hematuria.
An ultrasound was requested, which showed a 5 cm mass on the left lateral side of the bladder that produced hydronephrosis in the left kidney.
We performed a transurethral resection of the bladder with a high grade bladder tumour.
The extension study was negative.
The patient's creatinine was 2.5 mg/dl. Laparoscopic radical cystoprostatectomy with Bricker urinary diversion was performed in March 2005 (high grade non-Mo pT2b affecting the trigonal area and posterior face).
The surgical course was favorable.
In the postoperative follow-up one month after surgery, the patient had a reduction in left hydronephrosis while maintaining a certain degree of cortical deterioration and improved renal function (creatinine 1.65 mg/dl).
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The patient had very poor tolerance to the stoma, insisting on conversion to a continent diversion.
This situation is suggested by the improvement of renal function.
At two months 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 less than 80 cc.
The patient was discharged on the sixth postoperative day without complications.
Five months after surgery, it is continent during the day and night, with proper placement of the reservoir.
Both patients were highly informed about the risks of surgery and its possible complications, as well as the potential sequelae in terms of metabolic disorders, persistent diarrhea and incontinence and/or the need for self-catheterization.
In both cases, Bricker's loop was coated from the abdominal wall and after fixation, the neobladder chimney was anastomosed, not requiring ureteral reimplantation.
The bladder catheter was removed at 3 weeks, achieving both continence in a short time.
Both patients were very satisfied with the orthotopic derivation.
