Spontaneous rupture of orthotopic detubularized ileal bladder replacement: Report of 5 cases

Purpose: We defined the mechanisms responsible for rupture of orthotopic, detubularized ileal bladder replacement. Materials and Methods: We reviewed retrospectively the records of 5 cases of ileal neobladder rupture treated at our center between 1985 and 1995. Results: The interval to perforation varied from 3 to 60 months after surgery. The perforation site was typically the upper part of the right limb of the reservoir. We observed an acute episode of bladder over distension immediately before perforation in 2 cases and a chronic state of neobladder over distension in the 3 remaining cases, Bacterial infection was associated in 4 cases. Intraperitoneal adhesions were an associated mechanism for rupture in only 1 case. We found chronic ischemic changes weakening the bladder wall to be an additional factor for rupture in the 3 cases associated with chronic over distension. Conclusions: Acute or chronic over distension of the neobladder is the main factor for spontaneous rupture of orthotopic detubularized ileal bladder replacement. Chronic ischemic changes of the bladder wall, possibly facilitated by detubularization and the variability of the mesenteric circulation, are additional factors that lead to perforation.