Background: We reviewed our experience with orthotopic continent urinary reconstruction after radical cystectomy to assess the feasibility of Studer ileal neobladder for patients who are relatively advanced in age.
Methods: Between June 1997 and January 2005, 31 consecutive male patients (mean age: 64 years) underwent lower urinary tract reconstruction after radical cystoprostatectomy. Perioperative and late complications, functional outcome of the neobladder, urinary continence, upper urinary tract status and renal function with the metabolic balance were evaluated in all patients.
Results: There was no perioperative death, and perioperative and late complication rates were 22.8% and 3.3%, respectively. All 31 patients were able to void urine. Although the mean maximal functional capacity of the neobladder was 122 ml at 1 month after surgery, the mean capacities were increased to 247 ml at 6 months and 321 ml at 1 year after the operation. Urodynamic results at 3 years showed unchanged characteristics as to micturition pattern and volume of residual urine and neobladder pressure remained low. Of 31 patients, 29 (93.5%) showed excellent or good continent status during the daytime and 9 (29%) were completely dry at night in 6 months after surgery. Even at 3 years after the operation, only 1 patient out of 21 evaluated required single pad during nighttime. In a subgroup of five patients (24%) older than 70 years, the status of continence was satisfactory at 3 years after the reconstruction, and only one patient required a pad during the night at that point. Renal function levels and metabolic status were comparable before surgery and 3 years after surgery. Moreover, pyelography revealed normal condition of the upper urinary tract 1 month postoperatively in almost all cases.
Conclusions: These data provide evidence that Studer ileal neobladder is a satisfactory surgical technique for selected patients at our institute. Even for patients older than 70 years, this urinary diversion procedure is safe in terms of morbidity and efficacious as indicated by functional outcome.