Functional Outcome and Complications following Ileal Neobladder Reconstruction in Male Patients without Tumor Recurrence. More than 35 Years of Experience from a Single Center.

Autor:	Hautmann RE; Department of Urology, University of Ulm, Neu-Ulm, Germany., Volkmer B; Department of Urology, Klinikum Kassel, Kassel, Germany., Egghart G; Department of Urology, Kreiskrankenhaus Sigmaringen, Sigmaringen, Germany., Frohneberg D; Department of Urology, Klinikum Karlsruhe, Karlsruhe, Germany., Gottfried HW; Department of Urology, Evangelisches Krankenhaus, Göttingen-Weende, Germany., Gschwend J; Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany., Hefty R; Department of Urology, Klinikum Heidenheim, Heidenheim, Germany., Kleinschmidt K; Department of Urology Helios Dr.-Horst-Schmidt Kliniken, Wiesbaden, Germany., Küfer R; Department of Urology, Klinik am Eichert Göppingen, Göppingen, Germany., Miller K; Department of Urology, Charité University Berlin, Berlin, Germany., de Petriconi R; Department of Urology, University of Ulm, Neu-Ulm, Germany., Simon J; Department of Urology, Ortenau Klinikum Offenburg, Offenburg, Germany., Wenderoth U; Department of Urology, Klinikum Heidenheim, Heidenheim, Germany.
Jazyk:	angličtina
Zdroj:	The Journal of urology [J Urol] 2021 Jan; Vol. 205 (1), pp. 174-182. Date of Electronic Publication: 2020 Aug 28.
DOI:	10.1097/JU.0000000000001345
Abstrakt:	Purpose: There is a lack of data on true long-term functional outcome of orthotopic bladder substitution. The primary study objective was to report our 35-year clinical experience. Materials and Methods: Since October 1985, 259 male patients from a large single center radical cystectomy series with complete followup of more than 60 months (median 121, range 60-267) without recurrence, irradiation or undiversion that might have affected the functional outcome, were included. Results: Median age at radical cystectomy and at survey was 63 (range 23-81) and 75 (range 43-92) years, respectively. Overall 87% of patients voided spontaneously and residual-free. This rate decreased with increasing age at the time of surgery (less than 50 years old 94%, 70 years old or older 82%). Overall day/nighttime continence rates were 90%/82%. These rates decreased with increasing age at the time of surgery from 100%/88% to 87%/80%. The overall pad-free rate was 71%/47%. Bicarbonate use decreased from 51% (5 years) to 19% (25 years). Patients with a followup of more than 20 years had the lowest rate of residual urine and clean intermittent catheterization (0.0%) as well as use of more than 1 pad at daytime/nighttime (6.3%/12.5%) and mucus obstruction (0.0%). Serum creatinine showed only the age related increase. The surgical complication rate was 27% and correlated inversely with functional results (chi-squared 11.227, p <0.005), even when the younger age at the time of surgery (younger than 60 years) was related to higher rates of surgical complications (chi-squared 6.80, p <0.05). Conclusions: The ileal neobladder represents an excellent long-term option for urinary diversion with an acceptable complication rate.
Databáze:	MEDLINE
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