PubMed2000
OBJECTIVE: To analyze the outcome, complications and functional results in patients undergoing bladder substitution with the Studer continent urinary pouch. METHODS: The clinical records of 6 male patients who underwent radical cystectomy for invasive bladder cancer and bladder substitution with the Studer reservoir at our hospital from January 1996 to February 2000 were reviewed. Patient mean age was 54.2 years and mean follow-up was 14 months. Follow-up evaluation included abdominopelvic CT, chest x-ray, urinalysis, blood biochemistry, venous gasometry and ultrasonography with evaluation of postvoid residual urine. RESULTS: Transitional cell carcinoma was found to be the most frequent histopathological type. Distribution by grade and pathological stage showed they were all high grade infiltrating tumors localized to the bladder. Four patients are free of disease, one died from metastatic disease and one patient with tumor progression and multiple lung metastases at two months' follow-up is currently on chemotherapy. The mean operating time was significantly longer for this procedure than for the non-continent Bricker urinary diversion (mean 7.2 hours vs 3.5 hours, respectively). The immediate postoperative complications were: ileus (> 7 days) in two patients, diarrhea (> 3 days) in two, occlusive ileus due to fecaloma in one, metabolic acidosis in one, wound seroma in one, and wound infection in two patients. The early and late postoperative complications were: incontinence for up to one month after removing the urethral catheter in three patients (two of these patients are still incontinent at two months' follow-up), wound infection in two and impotence in 6 patients. CONCLUSION: Reservoir function in the medium-term is good; spontaneous urethral micturition and continence are maintained. To achieve good results, patients should be followed carefully and should be given detailed information about postoperative care and management.