Patients with an Orthotopic Low Pressure Bladder Substitute Enjoy Long-Term Good Function.

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Orthotopic bladder substitution is a long-standing procedure, yet comprehensive long-term functional outcome data remain limited.
• Radical cystectomy necessitates urinary diversion, with orthotopic bladder substitution being a reconstructive option.

Purpose of the Study:

• To evaluate the long-term functional outcomes of ileal orthotopic bladder substitution.
• To assess continence rates, voiding function, renal function, and complication rates up to 20 years post-surgery.

Main Methods:

• Retrospective analysis of 200 patients (181 men, 19 women) who underwent radical cystectomy and ileal orthotopic bladder substitution between 1985 and 2004.
• Inclusion criteria required a minimum of 10 years of follow-up.

Main Results:

• Daytime and nighttime continence rates remained high, peaking at 24 months and showing slight declines over two decades (e.g., 20-year daytime continence: 79%).
• Less than 3% experienced significant urine loss (>100 ml) during the day, and 10% at night, 10+ years post-surgery.
• Renal function showed a slow decline (<1 ml/min/1.73 m²/year) after initial postoperative changes. Complications occurred in 21% of patients, with pyelonephritis being most common.

Conclusions:

• Ileal orthotopic bladder substitution offers satisfactory long-term urinary continence and spontaneous voiding capabilities.
• Patients surviving 20 years post-procedure experience only physiological renal function decline and maintain functional outcomes.