IlealOrthotopicBladderSubstituteCombinedwithan AfferentTubularSegment:Long-TermUpperUrinaryTract ChangesandVoidingPattern Petros Perimenis * , Fiona C. Burkhard, Thomas M. Kessler, Tobias Gramann, Urs E. Studer Department of Urology, University Hospital of Bern, CH-3010 Bern, Switzerland Accepted 9 July 2004 Available online 29 July 2004 Abstract Objective: Assessment of the long-term morbidity of the upper urinary tract and of the voiding pattern in men with an ileal orthotopic bladder substitute with an afferent tubular segment. Materials and Methods: Men surviving more than 5 years after radical cystectomy and orthotopic bladder substitution were evaluated. The urinary tract was regularly assessed with ultrasound and IVU while functional reservoir capacity and continence status were prospectively assessed by voiding volume diaries and a standardized questionnaire. Results: After 5 years 129, after 10 years 45 and after 15 years 8 patients were evaluable. Median age at surgery was 63 years (range 36–80) and median follow-up was 73 months (range 60–201). Of the 254 renal units assessed between April 1985 and September 1998, 199 (78%) had some degree of dilatation in the 20-minute IVU film but rarely at 60 minutes. In 246 (97%) the parenchyma size was normal. Ureteral obstruction presented in 9 (3.5%) units, 4 of which were complete (3 had obstruction preoperatively and 1 postoperatively). Mean creatinine levels remained unchanged from the preoperative values. Functional reservoir capacity averaged 462 ml after 1 year, remained stable and then decreased slightly after 5 years. The daytime continence rate was 94% and 91% after 5 and 10 years, while the nighttime rate was 72% and 60% respectively. Patient age at the time of surgery was an important determinant for reservoir capacity and continence status. Conclusions: These data suggest that an orthotopic bladder substitution combined with an afferent tubular segment offers a sufficient protection of the upper tract with a low complication rate and has good long-term voiding and continence results. Meticulous lifelong follow-up is an important factor for satisfactory functional long-term outcome. # 2004 Elsevier B.V. All rights reserved. Keywords: Bladder neoplasms; Cystectomy; Urinary diversion 1. Introduction The improvement in survival of patients under- going radical cystectomy for muscle invasive bladder cancer raises the issue of long-term upper urinary tract changes and functional voiding patterns in patients with an orthotopic bladder substitute [1,2]. Due to the fact that these types of urinary diversion have only become popular during the last decade, information regarding morphological changes of the upper urinary tract and neobladder function is limited and is often comprised of mixed data on short, median and long-term results. Only long-term results ulti- mately decide whether orthotopic bladder substitution is here to stay. The technique with a tubular afferent segment was established at our institution in 1984 and has been used since [3]. We present the outcome of a consecutive series of 129 men who have been European Urology European Urology 46 (2004) 604–609 * Corresponding author. Current address: University of Patras, Medical School, Rio, Patras, Greece. Tel. +30 2610 999381; Fax: +30 2610 994668. E-mail address: perimenis@internet.gr (P. Perimenis). 0302-2838/$ – see front matter # 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2004.07.009