The use of detubularized terminal ileum and cecum to construct a highly compliant, low-pressure, continent ileocolonic pouch was first described by Light and Engelman and was termed the "Le Bag." Results were excellent in terms of continence and preservation of renal function; however, nocturnal incontinence persisted in a substantial number of patients. We have modified the original procedure in 17 patients by performing a urethral-cecal anastomosis instead of using a tail of nondetubularized ileum. In addition, in those patients in whom a urethral anastomosis is contraindicated, we have modified the nipple as the continence-providing mechanism. Overall daytime and nighttime continence rate is 94 percent. Of the 13 patients with urethral-cecal anastomoses, only 1 patient requires intermittent catheterization. The remainder are voiding by Valsalva maneuver and with minimal residual urine. Based on our experience with the Le Bag ileocolonic pouch, we believe it is an excellent choice for total bladder replacement or continent diversion--the advantages being the relative ease of construction, minimal long-term complications, and near total urinary continence.
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