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Functional Outcome and Complications following Ileal Neobladder Reconstruction in Male Patients without Tumor Recurrence. More than 35 Years of Experience from a Single Center.

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.