Long-term voiding pattern of patients with ileal orthotopic bladder substitutes

Good long-term functional outcome of orthotopic bladder substitution will ultimately decide whether it is here to stay. Therefore, we analyzed exclusively voiding patterns of long-term survivors with an orthotopic ileal bladder substitute.

In all patients with an ileal orthotopic bladder substitute day and nighttime continence status, voiding frequency, bladder capacity and pad usage were prospectively assessed by frequency volume charts and a standardized questionnaire. All men surviving 5 or more years with a median followup of 95 months (range 60-132) were evaluated.

Spontaneous voiding was possible in 82 of 86 (95.3%) evaluable patients after catheter removal. Daytime continence increased from 61% after 3 months to 92% at 12 months and remained stable throughout the following 4 years yet decreased slightly thereafter. Nocturnal continence rates were 10% to 15% lower throughout the study period. Functional reservoir capacity averaged 473 ml. after 12 months and did not change in subsequent years. After a decrease during the first 12 months, daytime frequency (4.1 to 4.8 times daily) and nocturia (1.8 to 2.3 a night) did not change in the next decade. Patient age at surgery was an important determinant for long-term reservoir capacity, nocturia and continence status.

These data provide evidence for good long-term functional outcome following orthotopic ileal bladder substitution up to 11 years. We attribute the sustained ability to void to the relatively small reservoir size, which is made of 40 to 44 cm. of ileum, the avoidance of any funnel shaped outlet but rather a side-to-end intestine-urethral anastomosis as well as lifelong meticulous followup.