There is a lack of data on true long term functional outcome of orthotopic bladder substitution. The primary objective was, to report our 35 year clinical experience.
Since October 1985 259 male patients from a large single center radical cystectomy series with complete follow up of >60 months (median 121, range 60-267) without recurrence, irradiation or undiversion, that might have affected the functional outcome, were included.
Median age at radical cystectomy and at survey was 63 (range 23-81) and 75 (range 43-92) years, respectively. 87% of patients voided spontaneously and residual free. This rate decreased with increasing age at the time of surgery (< 50y: 94%, 70y+: 82%). Overall day/night time continence rates were 90%/82%, respectively. These rates decreased with increasing age at the time of surgery from 100%/88% to 87%/80%. The overall pad-free rate was 71%/47%. Bicarbonate use decreased from 51% (5y) to 19% (25y). Patients with a follow up of >20 years had the lowest rate of residual urine and CIC (0.0%) as well as use of >1 pad at day/night time (6.3%/12.5%), and mucus obstruction (0,0%). Serum creatinine showed only the age related increase. The surgical complication rate was 27% and correlated inversely with functional results (X2 11.227, p<0.005), even when the younger age at the time of surgery (<60y) was related to higher rates of surgical complications (X2 6.80,p<0.05).
The ileal neobladder represents an excellent long term option for urinary diversion with an acceptable complication rate.
The Journal of urology. 2020 Aug 28 [Epub ahead of print]
Richard E Hautmann, Björn Volkmer, Günther Egghart, Detlef Frohneberg, Hans-Werner Gottfried, Jürgen Gschwend, Robert Hefty, Klaus Kleinschmidt, Rainer Küfer, Kurt Miller, Robert de Petriconi, Jörg Simon, Ulrich Wenderoth
Department of Urology, University of Ulm, Neu-Ulm, Germany., Department of Urology, Klinikum Kassel, Kassel, Germany., Department of Urology, Kreiskrankenhaus Sigmaringen, Sigmaringen, Germany (Deceased)., Department of Urology, Klinikum Karlsruhe, Karlsruhe, Germany., Department of Urology, Evangelisches Krankenhaus, Göttingen-Weende, Germany., Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany., Department of Urology, Klinikum Heidenheim, Heidenheim, Germany., Department of Urology Helios Dr.-Horst-Schmidt Kliniken,Wiesbaden, Germany., Department of Urology, Klinik am Eichert Göppingen, Göppingen, Germany., Department of Urology, Charité University Berlin, Berlin, Germany., Department of Urology, Ortenau Klinikum Offenburg, Offenburg, Germany.