Management of bladder cancer with Studer orthotopic neobladder: 13-year experience

We present the results of patients submitted to a Studer type urinary orthotopic derivation after radical cystectomy.

The files of patients with bladder cancer submitted to a radical cystectomy plus the procedure of the ileal neobladder were reviewed in our hospital from January 1992 until December 2004. Patients were divided into two groups: group A--60 years old or younger and group B-->60 years old.

From 306 patients submitted to radical cystectomy with urinary derivation, there were 42 patients (13.7%) included with Studer type neobladder. There were 34 (80.9 %) men and 8 (19.1%) women, with an average age of 60 years. Average surgical time was 7 h with an average blood loss of 1600 cc requiring transfer to intensive care unit (ICU) in 55% of the cases. The most frequent early complication was metabolic acidosis that was present in 28 (66%) patients. The most severe complication was ileal-ureter urinary leak, which was present in seven (16.6 %) patients. Among the most frequent late complications are the day- and night-time urinary incontinence often related to urinary infections and intestinal occlusion. Overall 5-year survival was 71%, cancer-specific mortality was 15% and surgical-related mortality was 7.3%.

The performance of procedures with orthotopic neobladders is actually feasible in experienced hospital centers and is a valuable alternative to urinary heterotopic derivation with ileal conduit. Postoperative patient management and regular follow-up is of major importance.