ILEAL ORTHOTOPIC BLADDER SUBSTITUTES

Orthotopic substitution of the bladder by a bowel segment, either following cystectomy or for bladder dysfunction, is currently well established. The requirements for an ideal intestinal bladder substitute are low pressure, adequate capacity, and a high compliance, which provide continence and voluntary control of voiding without residual urine. The patient must perceive when the bladder substitute is full, allowing him or her to void when convenient. Moreover, renal function must be preserved and intestinal malabsorption, fluid and electrolyte imbalance, long-term metabolic sequelae, and late neoplastic changes should be avoided. As yet not all of these requirements can be met simultaneously, so compromise is necessary. Our first experience with orthotopic low-pressure ileal reservoirs was gained from animal experiments performed in 1983 and 198423, 24 and initial use of the technique for bladder and ureteral replacement after simple or subtotal cystectomy in women with a shrunken bladder following radiotherapy. Urodynamic assessments confirmed the low-pressure characteristics of the ileal bladder substitute, which was made in analogy to Goodwin's et al5 cup-patch technique.19, 29 Subsequently, the procedure has been successfully used in more than 200 men and women. Based on this experience, we address several points that may help optimize the clinical results in patients with orthotopic ileal bladder substitutes.