Orthotopic bladder replacement - our experience on 93 cases

Abstract

Purpose: Orthotopic urinary tract reconstruction has become a standard surgery technique. Reservoir anastomoses to the urethra enables the patient to empty his bladder by micturition, avoiding the catheters use or external appliance. Materials and Methods: Between 1992 - 2001, 93 patients underwent radical cystectomy and orthotopic bladder replacement. All the patients have had bladder tumors, stage pT, - pT3 (1pT4) N0M0. 7 patients were NĂ (2 Nr 5 N2), 84 patients have had TCC, 3SCC, 3 fibrosarcomas, 1 adenocarcinoma, 2 cases of defunctionalized bladder. Patients' age is ranged between 38 - 74 years (71 males, 4 females). Follow-up between 7 and 126 months. Bladder replacement consisted in 55 cases with detubularized ileum (Carney, Studer, others) and 38 cases with detubularized sigmoid bowel (Reddy). Results: Postoperative early complications: urinary leakage (7), urinary fistula (1), ileal fistula (3), stercoral fistula (1), acute pyelonephrites (1), small bowel occlusion (1). Late complications: regional recurrence (7), metastasis (5) post-irradiation rectitis (1), acute pyelonephrites (2), ureter-neobladder strictures (2), neobladder urethral stenosis (3), pulmonary embolism (1), gastro-intestinal bleeding. 16patients died, 1 patient is lost of follow-up, Diurnal continence is very good 97,5%. Night continence is 65%. Urodynamic findings: mean bladder capacity 300 cc (ranged between 250 - 400 cc), mean intravesical pressure at maximum cystometric capacity was 51 cmH20 (40-60 cmH20), urethral profile - mean pressure 40 cmH20 (35-45 cmH20). Conclusions: These findings confirm that the orthotopic bladder replacement may be considered the choice method for urinary diversion after radical cystectomy. Our patients' continence rate is excellent and guarantees a good quality of life.