Twenty Years Experience With an Ileal Orthotopic Low Pressure Bladder Substitute—Lessons to be Learned

No AccessJournal of UrologyAdult urology1 Jul 2006Twenty Years Experience With an Ileal Orthotopic Low Pressure Bladder Substitute—Lessons to be Learned Urs E. Studer, Fiona C. Burkhard, Martin Schumacher, Thomas M. Kessler, Harriet Thoeny, Achim Fleischmann, and George N. Thalmann Urs E. StuderUrs E. Studer Department of Urology, University of Bern, Bern, Switzerland More articles by this author , Fiona C. BurkhardFiona C. Burkhard Department of Urology, University of Bern, Bern, Switzerland More articles by this author , Martin SchumacherMartin Schumacher Department of Urology, University of Bern, Bern, Switzerland More articles by this author , Thomas M. KesslerThomas M. Kessler Department of Urology, University of Bern, Bern, Switzerland More articles by this author , Harriet ThoenyHarriet Thoeny Institute of Diagnostic Radiology, University of Bern, Bern, Switzerland More articles by this author , Achim FleischmannAchim Fleischmann Institute of Pathology, University of Bern, Bern, Switzerland More articles by this author , and George N. ThalmannGeorge N. Thalmann Department of Urology, University of Bern, Bern, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(06)00573-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We present the long-term results of a large consecutive series of patients undergoing ileal orthotopic bladder substitution following radical cystectomy. Materials and Methods: Between April 1985 and 2005 orthotopic bladder substitution with an ileal low pressure reservoir was performed in 482 patients (including 40 women) after radical and, if possible, nerve sparing cystectomy. In 447 cases the procedure was combined with an afferent ileal isoperistaltic tubular segment. The patients were followed prospectively. Results: In the 482 patients 61 early (less than 30 days) diversion related complications requiring prolonged hospital stay or readmission were noted and 115 late complications required treatment. At 1 year continence was good in 92% of patients during the day and in 79% at night. At last followup 93% of patients could void spontaneously. Of 442 evaluable men 99 (22.4%) reported having erections without and 68 (15.4%) with medical assistance. Ureteroileal stenosis was observed in 12 of 447 (2.7%) patients. Urethral recurrence was detected in 25 of 482 (5%) patients. A total of 15 (5%) patients received vitamin B12 substitution. Renal parenchyma decreased only in patients with preoperative or postoperative ureteral obstruction. After 10 years patients with normal renal function had no long-term acidosis and in 20 patients the incidence of osteoporosis resembled that of the normal population. Conclusions: Ileal orthotopic bladder substitution combined with an afferent ileal tubular segment allows for good long-term functional results provided patients are restrictively selected, postoperative instructions are followed carefully, and typical complications such as outlet obstruction and hernias are treated early. References 1 : L’entéro-cystoplastie après cystoprostatectomie totale pour cancer de vessie. Ann Urol1979; 13: 114. Google Scholar 2 : Cup-patch technique of ileocystoplasty for bladder enlargement or partial substitution. Surg Gynecol Obstet1959; 108: 240. 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Volume 176Issue 1July 2006Page: 161-166 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordscystectomymetabolismbladderfollow-up studiesMetricsAuthor Information Urs E. Studer Department of Urology, University of Bern, Bern, Switzerland More articles by this author Fiona C. Burkhard Department of Urology, University of Bern, Bern, Switzerland More articles by this author Martin Schumacher Department of Urology, University of Bern, Bern, Switzerland More articles by this author Thomas M. Kessler Department of Urology, University of Bern, Bern, Switzerland More articles by this author Harriet Thoeny Institute of Diagnostic Radiology, University of Bern, Bern, Switzerland More articles by this author Achim Fleischmann Institute of Pathology, University of Bern, Bern, Switzerland More articles by this author George N. Thalmann Department of Urology, University of Bern, Bern, Switzerland More articles by this author Expand All Advertisement PDF downloadLoading ...