How to avoid clean intermittent catheterization in men with ileal bladder substitution.

Area of Science:

• Urology
• Oncology
• Surgical Innovation

Background:

• Ileal bladder substitution is a complex procedure following cystectomy for urothelial cancer.
• Assessing long-term functional outcomes, particularly spontaneous voiding, is crucial for patient quality of life.

Purpose of the Study:

• To determine the likelihood of spontaneous voiding failure in male patients with ileal bladder substitutes.
• To identify necessary corrective procedures and evaluate their eventual outcomes.

Main Methods:

• Analysis of a prospective departmental database of male patients undergoing ileal bladder substitution (1985-2002).
• Exclusion of patients requiring ileum conduit conversion; avoidance of funnel-shaped outlets post-initial cases.
• Inclusion of patients with a minimum 5-year follow-up for voiding assessment.

Main Results:

• At 5 years, 180 of 354 patients (51%) were alive and spontaneously voided within 3 months.
• 12% experienced voiding problems requiring de-obstructive procedures, with 98% achieving spontaneous voiding post-intervention.
• At 10 years, 13% of survivors experienced voiding issues, with 96% achieving spontaneous voiding after treatment.

Conclusions:

• Spontaneous voiding failure can occur after ileal bladder substitution.
• Avoiding funnel-shaped outlets and implementing timely de-obstructive surgery yields excellent long-term spontaneous voiding results.
• Clean intermittent catheterization may be avoided with appropriate surgical planning and management.