SUMMARY OF 10 YEARS EXPERIENCE WITH AN ILEAL LOW-PRESSURE BLADDER SUBSTITUTE COMBINED WITH AN AFFERENT TUBULAR ISOPERISTALTIC SEGMENT

We report on 10 years of experience with an ileal low-pressure bladder substitute combined with an afferent tubular segment following cystec tomy in 100 consecutive men. The median follow-up period was 30 months (range 3-108 months), with a 2.5-year minimum in survivors. A total o f 42 patients died, 33 of these dying of bladder cancer. The early com plication rate was 11%, including 2 deaths due to postoperative sepsis . In all, 14 patients required reoperation for late complications. The reservoir's median functional capacity increased to 500 ml at 12 mont hs and was paralleled by improving continence: 92% by day (after 1 yea r) and 80% by night (after 2 years). Four ureteric strictures occurred . No coordinated, isolated pressure rise developed in the reservoir du ring voiding, which was accomplished by pelvic floor relaxation with a bdominal straining, if necessary. Raised intraabdominal pressure acted equally on the reservoir and ureters, preventing reflux during voidin g. This technique is straightforward, allows radical cancer surgery, a nd protects the upper tract. The favorable functional results are comp arable with those achieved by similar techniques, but meticulous follo w-up is essential.