Hautmann and Studer orthotopic neobladders: a contemporary experience

The development of Studer and Hautmann orthotopic neobladders has revolutionized the management of urinary diversion. Several series have promoted 1 technique over the other. We examine the clinical outcome of a contemporary cohort of patients with bladder cancer who underwent either Hautmann or Studer orthotopic reconstruction.

Retrospective analysis was performed on 130 patients who underwent cystectomy and orthotopic diversion (Studer 93 and Hautmann 37) between March 1, 1995 and September 30, 2000. Clinical parameters evaluated were age, gender, procedure time, length of hospital stay, blood loss, pathological stage, and rates of complication, continence and reoperation. Diversion type was compared with clinical parameters using Fisher's exact test, t-test and Wilcoxon rank sum analysis.

Studer and Hautmann techniques had mean procedure times of 5.9 and 5.3 hours, respectively (p = 0.003), and mean length of stay was shorter for Hautmann than Studer (7.0 versus 8.3 days, respectively, p = 0.02). When comparing both populations there was no difference in age, gender, estimated blood loss, pathological stage or rates of complication and reoperation. Total continence was similar in the Hautmann and Studer cohorts, whether during the day (67% versus 67%) or at night (47% versus 40%), respectively.

The data suggest that both orthotopic techniques can be performed in men and women in a safe and timely fashion. Nighttime continence rates are slightly higher with the Hautmann technique, although not statistically different. The shortened Hautmann procedure time likely relates to variations in the ureteral anastomosis. Decreased length of stay may reflect recent trends of early hospital discharge.