Bladder cancer is a highly prevalent malignant tumor of the genitourinary system, and according to published statistics, the incidence ranks as the 4th most common tumor lesion in men and the 9th most common tumor in women. Clinically, bladder cancer is divided into two categories: non-muscle invasive bladder cancer (Ta-1 and Tis in situ, Non-Muscle invasive bladder cancer, NMIBC) and muscle invasive bladder cancer (MIBC). Most of them are invasive tumors at the beginning, but some of them progress from superficial bladder cancer, accounting for about 20% of superficial bladder cancer.
Currently, radical total cystectomy remains the gold standard treatment for muscle-invasive bladder cancer and refractory non-muscle-invasive bladder cancer. Urethral diversion after radical total cystectomy can be divided into three categories: abdominal wall stoma, urinary-fecal merger, and in situ neocystectomy. Drainage of urine via abdominal wall stoma causes inconvenience to patients and seriously affects their quality of life; urofecal colectomy has the risk of causing serious infection in the upper urinary tract. In the last decade or so, non-in situ cysts have been replaced by in situ cystectomies due to the increased demand for quality of life after surgery. In situ neocystectomy is becoming an ideal option for patients with invasive bladder cancer to reroute urine flow after radical total cystectomy.
The ideal in situ neocystectomy should meet the following criteria: large volume (400-500 ml), low-pressure urine storage, reliable anti-reflux mechanism, high compliance, good voiding ability, simple surgery, low surgical complication rate and reoperation rate, and no long-term metabolic complications. Most of the ileal, ileocolic or colonic substitution cysts currently used can meet these requirements, but each procedure has its own drawbacks, such as the high complication rate of Hautmann ileal substitution cyst, the complex structure of the input papilla flap of the hemi-Kock pouch, the high failure rate, and the poor diurnal urinary control rate of the T-shaped bladder. In contrast, Studer in situ ileal neocystoplasty is well designed and applied to ileal segments <60 cm, which has the advantages of low pressure, anti-reflux, simple technique, good postoperative voiding function, long input loop, and is suitable for long ureteral segment defects. We concluded from the long-term follow-up and evaluation of Bricker and Studer in situ cystectomies for total cystectomy for bladder cancer that the Bricker procedure protects renal function, has a low complication rate, has a relatively wide range of indications, and is still a common method for clinical urinary diversion. In contrast to the Bricker procedure, the Studer in situ ileal neocystoplasty requires a certain degree of patient cognition and urethral dilation. In situ ileal neobladder urinary reconstruction does not affect the prognosis of the tumor, but also enables the patient to control urine on his own without the need to hang a urinary bag outside the body, which is a relatively high quality of life and low complication rate.