Twenty years experience with an ileal orthotopic low pressure bladder substitute--lessons to be learned

Studer, Urs E; Burkhard, Fiona C; Schumacher, Martin; Kessler, Thomas M; Thoeny, Harriet; Fleischmann, Achim; Thalmann, George N (2006). Twenty years experience with an ileal orthotopic low pressure bladder substitute--lessons to be learned. Journal of urology, 176(1), pp. 161-6. New York, N.Y.: Elsevier 10.1016/S0022-5347(06)00573-8

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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.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology 04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology 04 Faculty of Medicine > Service Sector > Institute of Pathology
UniBE Contributor:	Studer, Urs, Burkhard, Fiona Christine, Kessler, Thomas M., Thöny, Harriet C., Fleischmann, Achim, Thalmann, George
ISSN:	0022-5347
ISBN:	16753394
Publisher:	Elsevier
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 14:46
Last Modified:	02 Mar 2023 23:22
Publisher DOI:	10.1016/S0022-5347(06)00573-8
PubMed ID:	16753394
Web of Science ID:	000238298000041
URI:	https://boris.unibe.ch/id/eprint/19256 (FactScience: 1751)