title: Radical cystectomy with orthotopic neobladder for invasive bladder cancer: a critical analysis of long-term oncological, functional, and quality of life results.
abstract: OBJECTIVE
  The present contribution analyses long-term data regarding oncological, functional, and quality of life aspects of patients subjected to cystectomy due to malignancy with subsequent orthotopic bladder substitution.
  
  
  METHODS
  A literature search was conducted to review literature published from 1887 until today. Oncological aspects, special considerations on female patients, quality of life, geriatric patients, and impact of minimally invasive surgery were also addressed and discussed.
  
  
  RESULTS
  After more than three decades, orthotopic bladder substitution subsequent to radical cystectomy has stood the test of time by providing adequate long-term survival and low local recurrence rates. Compared to radical cystectomy, neither radiation nor chemotherapy, nor a combination of both, offer similar long-term results. Orthotopic bladder substitution does not compromise oncological outcome and can be performed with excellent results regarding functional and quality of life issues. Chronological age is generally not a contraindication for cystectomy.
  
  
  CONCLUSIONS
  Orthotopic bladder substitution should be the diversion of choice both in men and in women, whenever possible. For orthotopic urinary diversion, a careful patient selection considering tumor extent, patient motivation, preoperative sphincter function, other local and systemic adverse confounding factors, and overall life expectancy must be taken into account. Minimally invasive techniques are promising concepts for the future, awaiting confirmation in larger patient cohorts.
authors.affiliation: Department of Urology and Andrology, General Hospital Hall i.T., A.ö. Bezirkskrankenhaus (BKH) Hall i.T., Milser Str. 10, 6060, Hall i.T., Austria. Udo.Nagele@bkh-hall.or.at
authors.forename: Udo
authors.initials: U
authors.lastname: Nagele
authors.forename: Aristotelis G
authors.initials: AG
authors.lastname: Anastasiadis
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.forename: Markus
authors.initials: M
authors.lastname: Kuczyk
mesh_terms: D015653:Cystectomy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011788:Quality of Life; D015996:Survival Rate; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000502:physiology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000601:surgery*; D014547:Urinary Diversion / Q000295:instrumentation / Q000379:methods*; D016476:Urinary Reservoirs, Continent