الفهرس 
ORTHOTOPIC BLADDER SUBSTITUTIONOnly 14 pages are availabe for public view
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Abstract
Introduction: Orthotropic ileal neobladder has become the standard method of continent urinary reconstruction in patient undergoing cystectomy for bladder cancer. First radical cystectomy with orthotopic bladder substitution in a woman was performed in 1987. Long term evaluation of the functional and oncological results following orthotopic bladder substitution in women is our aim. In addition, assessment of chronic retention or hypercontinence, regarding its etiology, prevention and treatment. Patients and Methods: between January 1995 and December 2003, 192 women underwent orthotopic bladder replacement after radical cystectomy for muscle invasive bladder cancer. Mean age 51 years with exclusion criteria included clinically evident pelvic lymphadenopathy, bladder neck and / or vaginal wall involvement, positive intraoperative frozen section from the urethral stump and history of compromised continence mechanism. The mean follow up period 50 months. We evaluated the patients for functional and oncological outcomes. Moreover, early and late complications were studied. Results: local recurrence, including 2 cases with isolated urethral recurrence developed in 30 patients and distant metastasis in 16. Regarding the functional outcome we found chronic retention in 16 %. 73 late complications developed in 60 patients such as (stone disease, ureteroileal stricture, reflux, pyelonephritis), which were treated to resolve these complications. Conclusion: The low rate of urethral recurrence after this operation justifies the continued performance of this type of diversion in selected women. Also a satisfactory functional outcome is achieved after this type of operation. The chronic retention of urine is a significant problem after this operation; however, its incidence can be minimized by performing some technical modifications and also could be managed by CIC (clean intermittent catheterization). Close follow up is mandatory to detect oncological failure as well as early and late complications.