No abstract

OBJECTIVE To assess, in a retrospective three‐centre series, a second analysis of the initial experience and results of patients undergoing radical cystectomy (RC) and orthotopic neobladder reconstruction (ONR) after an additional 4 years of follow‐up. PATIENTS AND METHODS The medical records of 104 suitable consecutive patients undergoing RC and ONR between June 1994 and April 2003 were reviewed retrospectively. The complications, mortality, continence and cancer control rates were all recorded. RESULTS The median (range) follow‐up was 88 (52–156) months; 90 patients had reconstruction with a ‘Studer’ neobladder, 12 with a Hautmann W pouch and 2 with a ‘T pouch’ ileal neobladder. There were 24 early complications, and one death after surgery. There were 32 late complications. The daytime continence rate was 98% and the nocturnal continence rate was 76%. Ten patients required intermittent self‐catheterization (ISC). In all, 30 patients had local and/or distant recurrences, all of whom died. Seven patients died from other causes. CONCLUSIONS ONR provides excellent long‐term continence rates and both acceptable complication and mortality rates. Suitable patients undergoing RC should be offered ONR.

OBJECTIVETo assess, in a retrospective three-centre series, the initial experience and results of patients undergoing radical cystectomy and orthotopic neobladder reconstruction. PATIENTS AND METHODSThe medical records were retrospectively reviewed for 104 suitable consecutive patients undergoing radical cystectomy and orthotopic neobladder reconstruction between June 1994 and April 2003. The initial histology, operating times, transfusion rates, complications, mortality rates, continence rates, potency rates, and cancer control rates were recorded. RESULTSThe median (range) follow-up was 48 (6-113) months; 90 patients had a reconstruction with a 'Studer' neobladder, 12 with a 'Hautmann W pouch' and two with a 'T pouch' ileal neobladder. There were 24 early complications, and in eight patients reoperation was required; there was one death after surgery. There were 14 late complications and 10 patients required reoperation. The daytime continence rate was 99% and the nocturnal continence rate 78%. Five patients required intermittent selfcatheterization. Twenty-two patients died from local and/or distant recurrences, and four from other causes. CONCLUSIONSOrthotopic neobladder reconstruction provides excellent continence rates, and both acceptable complication and mortality rates. Suitable patients undergoing radical cystectomy should be offered orthotopic neobladder reconstruction. KEYWORDSradical cystectomy, orthotopic neobladder reconstruction, continent urinary diversion.

Symptoms of sexual dysfunction are common in patients recovering from critical illness and appear to be significantly associated with the presence of post-traumatic stress disorder symptomatology. The intensive care unit follow-up clinic is a suitable forum for the screening and referral of patients with sexual dysfunction.