**4. Techniques for orthotopic bladder substitution**

Reservoirs made of detubularized ileum or ileum and colon together, appear to have the greatest compliance and lowest likelihood of generating intermittent highpressure contractions.

The circular muscle layer of ileum was found to be most distensible, and the urodynamic characteristics of the ileum appear to be superior to those of the colon.

According to Schrier, ileum neobladders have the larger capacity, lower pressures and better compliance. Likewise, small bowel mesentery has the greatest mobility and can reach to the urethra without much tension [1].

Furthermore, another advantage of the ileum is the intestinal mucosa atrophy, due to the chronic exposure to urine. As a result, mucous production is decreased as well as reabsorption of urinary electrolytes. Mucosal atrophy appears to be more frequent in small bowel reservoirs.

Isolation of the segment of bowel to be used for the diversion must be performed carefully to preserve blood supply to the pouch, as well as to the bowel anastomosis.

The addition of an antireflux mechanism does not appear to be necessary for preservation of the upper tracts and prevention of infections, at least in the intermediate term [2].
