The Lahey clinic experience with continent urinary diversion

To compare the morbidity, mortality and clinical outcome of catheterizable continent urinary reservoirs (CUR) with orthotopic neobladders (ONB) at our institution.

Between September 1985 and October 2001, 238 patients (84 women and 154 men) had a continent urinary diversion, including 125 ONBs and 113 CURs. The charts of these patients were reviewed retrospectively and the patients interviewed by telephone when possible (for continence data and overall satisfaction). Over the 16 years the relative frequency of ONB diversion increased steadily and thus the mean follow-up was significantly longer for the CUR (9.4 years) than for the ONB group (5.2 years) (P < 0.001). This bias was addressed by comparing these large groups for the early outcome only. Separately, the long-term outcome was analysed, comparing the 40 most recently constructed CURs with all 113 ONBs; this gave a mean follow-up of 5.2 years for ONB and 5.9 years for CUR (not significant, P = 0.23).

Of the 238 continent diversions, 125 were ONBs and 113 CURs; most patients had a diagnosis of transitional cell carcinoma before surgery. The mean age at surgery was 59.1 years for the ONB and 54.8 years for the CUR group (P < 0.001). Men were significantly more likely than women to have had an ONB. There were two deaths after surgery in the ONB and none in the CUR group. The hospital stay was significantly longer for the CUR than for the ONB group; the likelihood of an intensive care unit stay, estimated blood loss and reoperation rate were higher in the CUR group. There was no significant difference in the rates of short-term (<30 days) complications. The analysis of the time-controlled groups showed significantly more long-term (>30 days) complications and of reoperation in the CUR group. Fifty-one patients with ONB and 19 with CURs were contacted by telephone; of those with an ONB, 43 (84%) had daytime continence (<1 pad/day) while 13 (25%) were continent at night (<1 pad). Fifteen of 19 with a CUR reported full day and night-time continence. From separate telephone interviews, overall satisfaction was high for both groups (mean 4.5, scale 0-5), expectations were met in 92% for both, and 94% in both would choose the same procedure again if confronted with the same set of circumstances.

Both ONB and CUR offer an excellent functional outcome, as reflected by patient satisfaction and continence rates.