J Urol. 2020 Aug 28:101097JU0000000000001345. doi: 10.1097/JU.0000000000001345. Online ahead of print.
PURPOSE: There is a lack of data on true long term functional outcome of orthotopic bladder substitution. The primary objective was, to report our 35 year clinical experience.
MATERIAL AND METHODS: Since October 1985 259 male patients from a large single center radical cystectomy series with complete follow up of >60 months (median 121, range 60-267) without recurrence, irradiation or undiversion, that might have affected the functional outcome, were included.
RESULTS: Median age at radical cystectomy and at survey was 63 (range 23-81) and 75 (range 43-92) years, respectively. 87% of patients voided spontaneously and residual free. This rate decreased with increasing age at the time of surgery (< 50y: 94%, 70y+: 82%). Overall day/night time continence rates were 90%/82%, respectively. These rates decreased with increasing age at the time of surgery from 100%/88% to 87%/80%. The overall pad-free rate was 71%/47%. Bicarbonate use decreased from 51% (5y) to 19% (25y). Patients with a follow up of >20 years had the lowest rate of residual urine and CIC (0.0%) as well as use of >1 pad at day/night time (6.3%/12.5%), and mucus obstruction (0,0%). Serum creatinine showed only the age related increase. The surgical complication rate was 27% and correlated inversely with functional results (X2 11.227, p<0.005), even when the younger age at the time of surgery (<60y) was related to higher rates of surgical complications (X2 6.80,p<0.05).
CONCLUSIONS: The ileal neobladder represents an excellent long term option for urinary diversion with an acceptable complication rate.