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J Urol ; 205(1): 174-182, 2021 Jan.
Article in English | MEDLINE | ID: mdl-32856988

ABSTRACT

PURPOSE: There is a lack of data on true long-term functional outcome of orthotopic bladder substitution. The primary study objective was to report our 35-year clinical experience. MATERIALS AND METHODS: Since October 1985, 259 male patients from a large single center radical cystectomy series with complete followup of more than 60 months (median 121, range 60-267) without recurrence, irradiation or undiversion that might have affected the functional outcome, were included. RESULTS: Median age at radical cystectomy and at survey was 63 (range 23-81) and 75 (range 43-92) years, respectively. Overall 87% of patients voided spontaneously and residual-free. This rate decreased with increasing age at the time of surgery (less than 50 years old 94%, 70 years old or older 82%). Overall day/nighttime continence rates were 90%/82%. 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% (5 years) to 19% (25 years). Patients with a followup of more than 20 years had the lowest rate of residual urine and clean intermittent catheterization (0.0%) as well as use of more than 1 pad at daytime/nighttime (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 (chi-squared 11.227, p <0.005), even when the younger age at the time of surgery (younger than 60 years) was related to higher rates of surgical complications (chi-squared 6.80, p <0.05). CONCLUSIONS: The ileal neobladder represents an excellent long-term option for urinary diversion with an acceptable complication rate.


Subject(s)
Ileum/surgery , Postoperative Complications/epidemiology , Urinary Bladder Neoplasms/surgery , Urinary Diversion/adverse effects , Urinary Incontinence/epidemiology , Urinary Reservoirs, Continent/adverse effects , Adult , Age Factors , Aged , Aged, 80 and over , Cystectomy/adverse effects , Female , Follow-Up Studies , Humans , Incidence , Incontinence Pads/statistics & numerical data , Intermittent Urethral Catheterization/statistics & numerical data , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/therapy , Prospective Studies , Severity of Illness Index , Treatment Outcome , Urinary Bladder/pathology , Urinary Bladder/surgery , Urinary Bladder Neoplasms/pathology , Urinary Diversion/methods , Urinary Incontinence/diagnosis , Urinary Incontinence/etiology , Urinary Incontinence/therapy , Young Adult
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