title: Patients with an Orthotopic Low Pressure Bladder Substitute Enjoy Long-Term Good Function.
abstract: OBJECTIVE
  Orthotopic bladder substitution has been performed on a regular basis for more than 30 years and yet data on long-term functional outcomes are still lacking.
  
  
  METHODS
  We evaluated 181 men and 19 women who underwent radical cystectomy and urinary diversion with ileal orthotopic bladder substitution from 1985 to 2004 and who had 10 years or more of followup.
  
  
  RESULTS
  Median age at radical cystectomy was 63 years (IQR 57-69). Median followup was 167 months (IQR 137-206). Daytime and nighttime continence rates peaked 24 months postoperatively and decreased slightly thereafter during almost 2 decades. At 10, 15 and 20 years daytime continence rates were 92%, 90% and 79%, and nighttime continence rates were 70%, 65% and 55%, respectively. During the day and at night fewer than 3% and 10% of patients, respectively, had urine loss 100 ml or greater at any time 10 years or longer after surgery. At 10 and 20 years 11 of 200 patients (6%) and 1 of 29 (3%), respectively, had to perform clean intermittent self-catheterization. After an initial postoperative decrease in the estimated glomerular filtration rate the subsequent decrease was less than 1 ml/minute/1.73 m(2) per year. A total of 81 complications were observed in 42 of the 200 patients (21%) 10 years or longer after radical cystectomy with pyelonephritis as the most frequent cause.
  
  
  CONCLUSIONS
  Patients who survive up to 20 years after radical cystectomy and diversion with an ileal orthotopic bladder substitution may enjoy satisfactory urinary continence and retain the ability to void spontaneously while experiencing no more than a physiological decrease in renal function.
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Furrer
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Roth
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kiss
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Nguyen
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Silvan
authors.initials: S
authors.lastname: Boxler
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Burkhard
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: George N
authors.initials: GN
authors.lastname: Thalmann
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland. Electronic address: urs.studer@insel.ch.
authors.forename: Urs E
authors.initials: UE
authors.lastname: Studer
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D001743:Urinary Bladder / Q000503:physiopathology* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000503:physiopathology / Q000601:surgery*; D014554:Urination / Q000502:physiology*
keywords: cystectomy; elderly; quality of life; urinary diversion; urinary incontinence