Orthotopic bladder substitution in women: Functional evaluation

Purpose: Orthotopic bladder substitution following cystectomy in women has recently been introduced at some specialized centers. Studies of such a pro cedure should consider the oncological and functional outcomes. We analyzed only the functional results of orthotopic bladder substitution since follo wup is too short (about 2 years) for a valid oncological assessment. Materials and Methods: From October 1994 to November 1997, 60 women with a mean age of 48.3 years underwent standard radical cystectomy and orthotopic diversion (ileal W-neobladder with subserous tunnel in 47 and hemi-Kock re servoir in 13). The oncological criterion was organ confined invasive bladd er cancer. Results: There was no perioperative mortality. Postoperative complications included fatal pulmonary embolism in 1 woman, deep vein thrombosis in 2, pr olonged ileus in 1 and fistula of the vaginal pouch in 3, which was repaire d successfully. Cancer recurred in the pelvis in 2 cases and as distant met astases in 5. Of the patients 43 had been followed for a mean of 20.2 month s (range 6 to 36), and 32 were continent day and night, 1 was totally incon tinent, 2 had daytime stress incontinence and 6 had nighttime incontinence. Six women had difficulty emptying the pouch spontaneously with concomitant residual urine due to acute angulation between the urethra and pouch. Conclusions: Orthotopic bladder substitution after standard radical cystect omy in select women provides a satisfactory functional outcome. Failure of complete emptying seems to be due to anatomical rather than functional reas ons.