Female orthotopic bladder substitution: A good operation in the right circumstances

Purpose: We present the long-term results of orthotopic bladder substitutio n in women. Materials and Methods: We prospectively assessed 15 female patients undergo ing orthotopic bladder substitution between October 1984 and April 1998. Th e indication for diversion was bladder carcinoma in 8 cases, gynecologic ma lignancy in 2 and benign disease in 5. Results: At a median followup of 19 months daytime and nighttime continence was 100% and 89% respectively. All but 1 patient voided spontaneously. Two patients who were initially able to void successfully had voiding difficul ties in the initial 10 months due to prominent mucosal tissue at the bladde r neck. In each case this condition was successfully managed by endoscopic resection. There has been no local recurrence of bladder carcinoma. Conclusions: With strict selection criteria smd vigilant followup female or thotopic bladder substitution produces excellent long-term functional resul ts comparable to those in men. However, the limits in women who require rad ical cystectomy for invasive bladder cancer cannot be determined from our r esults. Further long-term data on the local recurrence rate of invasive uro thelial malignancy are needed before the true risk may be quantified accura tely.