Orthotopic neobladder reconstruction in elderly bladder cancer patients

Background: We compared the clinical results of orthotopic neobladder recon struction in elderly patients and those in younger patients retrospectively in order to verify whether age is a critical factor in selecting a method of urinary diversion. Methods: Following radical cystectomy for bladder cancer, 12 patients aged 75 or older and 17 patients under 75 who underwent orthotopic neobladder re construction between January 1992 and May 1999 were investigated in this st udy. The authors TS and BS were among the surgeons who performed operations for all cases. Of the 12 elderly patients, orthotopic neobladders were con structed according to Hautmann's method in nine cases, Studer's method in o ne case and Reddy's method in two cases. Of the 17 younger patients, these methods were employed in 12, one and four cases, respectively. Operative pr ocedure, early and late complications, prognosis, continence and voiding pa ttern were investigated in these patients. Results: The follow-up periods for elderly and younger groups ranged from 2 1.3 to 82.7 months and from 8.8 to 94.2 months, respectively. No difference in operation time, amount of bleeding or postoperative length of hospitali zation was observed between elderly and younger patients. The rates of earl y complications in elderly and younger patients were 41.7% and 35.3%, respe ctively. Late complication rates were 33.3% and 47.1%, respectively The dif ference in these complication rates was not statistically significant. One of the elderly and two of the younger patients had local recurrence and met astasis postoperatively. Those three patients had died of their bladder can cer. No statistically significant difference between groups was recognized in either cause-specific survival or overall survival, nor was there such a difference in relation to micturition/continence. Conclusion: Based on these results, we believe that because age is not a cr itical factor in the selection of urinary diversion method, neobladder reco nstruction following cystectomy for bladder cancer is indicated in elderly patients. As stoma management is difficult for the patients, we consider or thotopic neobladder reconstruction to be the method of choice if the patien ts' general physical condition allows.