Surgical methods

All operations were performed by a single surgeon. Radical cystectomy with pelvic lymphadenectomy was performed according to the guidelines established by (The National Institute for Health and Care Excellence) NICE [7]. A 40- to 45-cm-long ileal segment was isolated 30 cm proximal to the ileocecal valve, and the bowel continuity was then restored by a single-layer running suture. The ileal segment was dissected along its entire length of the contralateral border of the mesentery, and the mucus from the surface of the intestinal mucosa was cleared by an aspirator. In this step, surface mucus cells of the intestinal tract are sufficiently destroyed by anhydrous ethanol. To construct the reservoir, the prepared ileal segment was closed in a “spiral-shaped” manner (Fig. 1a, c). The end of the ureter was split 1 cm and everted in a “sleeve shape” for antirefluxing (Fig. 1b, d), and it was then anastomosed to the reservoir using a ureteral stent. To complete this procedure, two intestinal incisions slightly larger than the ureteral circumference were made at the contralateral edge of the bilateral mesangium intestine at the top of the new bladder, and the ureteral papilla and ureteral stent were clamped and pulled into the new bladder with noninvasive forceps, ensuring that the ureteral nipple and stent were located in the new bladder. This process was the same as that of the ureter entering the bladder. The ureter was anastomosed to the new bladder with a 4-0 absorbable line using the split-cuff nipple nonrefluxing technique. Ureteral stents were exposed through the reservoir and the anterior abdominal wall. The lowest end of the new bladder was cut 1 cm to insert an 18F urethral catheter, and a 2-0 absorbable line was used to suture the corresponding sites (2, 5, 7, and 10 o’clock positions) at the bottom of the new bladder for four stitches. After a suprapubic catheter was placed into the new bladder through the fat of the mesoileum, the pouch was closed completely. Ureteral stents were removed 7–10 days later, and the suprapubic catheter was removed 2 weeks later. The urethral catheter was removed 16–21 days after the operation to restore urethral urination.

The “spiral-shaped” neobladder and “sleeve-shaped” ureter. a During the surgery, the prepared ileal segment was closed in a “spiral-shaped” manner to construct the neobladder; b during the surgery, the end of the ureter was split 1 cm and everted in a “sleeve shape” for anti-refluxing; c a sketch map of the “spiral-shaped” neobladder; d a sketch map of the “sleeve-shaped” ureter