[Surgical urinary bladder replacement in cancer]

Radical cystectomy, where necessary combined with systemic chemotherapy, is currently regarded to be the treatment of choice in invasive bladder cancer. Compared with such procedures as colonic or ileal conduit the construction of a continent intestinal bladder substitution is not associated with any higher risks but offers a considerably better quality of life without significantly extending the duration of surgery. Our experience with the ileal-neobladder with non-reflux uretero-intestinal implantation described by LeDuc, and Kock's the thoroughgoing application principles to form a low pressure reservoir for bladder substitution, encouraged us to believe that a good long-term prognosis with respect to renal function can be expected. About 90% of all patients with ileal-neobladder are continent day and night. About half of them have sensory function and are capable of voiding urine completely by abdominal straining. For invasive bladder cancer, therefore, continent bladder substitution must be generally regarded to be the superior alternative to urinary diversion by conduit.