[What is the best bladder replacement].

Among the surgical options for bladder replacement proposed after cystectomy, the ileocaecal pouch system has been abandoned for twenty years because of its poor gastrointestinal tolerance. Colonic enterocystoplasty is useful because of the reduced risk of degeneration and fewer repercussions on gastrointestinal absorption. However, replacement with the ileum is today the reference cystoplasty with three main techniques: Hautmann bladder, Studer pouch and Foch Z-shaped pouch. According to the data in the literature, these techniques offer similar overall performances and the results therefore remain mainly operator-dependent. Efficacy in terms of urinary continence is optimized by the preparation of a detubularized neobladder with a "physiological" functional capacity, the preservation of the sphincter as well as perineal-abdominal re-education which is started immediately after surgery. Direct ureteral reimplantation in the detubularized bladder is today an effective and sufficient technique to prevent vesico-renal reflux. Tumor recurrences do not seem be dependent on the type of ureteral reimplantation, nor on the type of initial bladder tumor. Extemporaneous examination of the cross-section of normal urethral section (no tumor, dysplasia, or carcinoma in situ) makes it possible to exclude the risk of urethral recurrence.