Background: We compared the clinical results of orthotopic neobladder reconstruction in elderly patients and those in younger patients retrospectively in order to verify whether age is a critical factor in selecting a method of urinary diversion. Methods: Following radical cystectomy for bladder cancer, 12 patients aged 75 or older and 17 patients under 75 who underwent orthotopic neobladder reconstruction between January 1992 and May 1999 were investigated in this study. The authors TS and BS were among the surgeons who performed operations for all cases. Of the 12 elderly patients, orthotopic neobladders were constructed according to Hautmann's method in nine cases, Studer's method in one case and Reddy's method in two cases. Of the 17 younger patients, these methods were employed in 12, one and four cases, respectively. Operative procedure, early and late complications, prognosis, continence and voiding pattern were investigated in these patients. Results:The follow-up periods for elderly and younger groups ranged from 21.3 to 82.7 months and from 8.8 to 94.2 months, respectively. No difference in operation time, amount of bleeding or postoperative length of hospitalization was observed between elderly and younger patients. The rates of early complications in elderly and younger patients were 41.7% and 35.3%, respectively. Late complication rates were 33.3% and 47.1%, respectively. The difference in these complication rates was not statistically significant. One of the elderly and two of the younger patients had local recurrence and metastasis postoperatively. Those three patients had died of their bladder cancer. No statistically significant difference between groups was recognized in either cause-specific survival or overall survival, nor was there such a difference in relation to micturition/continence. Conclusion: Based on these results, we believe that because age is not a critical factor in the selection of urinary diversion method, neobladder reconstruction following cystectomy for bladder cancer is indicated in elderly patients. As stoma management is difficult for the patients, we consider orthotopic neobladder reconstruction to be the method of choice if the patients' general physical condition allows.

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Group B: 188 patients who were given amikacin 15 mg / kg intramuscularly 60-120 min before the procedure. All patients underwent urinalysis and urine culture before and after the procedure. We identified post biopsy complications: bacteriuria, urinary tract infection, orchitis, pyelonephritis, sepsis, all of them were evaluated, all patients with a severe condition were hospitalized. The variables were correlated using Fishers Exact Test.RESULTS: In Group A, 4.3% of patients presented a febrile UTI and 0.97% presented sepsis. In Group B, 5.3% presented febrile UTI and .53% presented sepsis. Comparing both groups, we found no relationship between the dose and the risk for complications (p¼0.52). In the group analysis considering DM, a significant relationship for complication risks was not found, Group A (p¼0.62) and Group B (p¼0.58). The same in the analysis of overweight and obesity no significant relationship with complications was found, Group A (p¼0.85) and Group B (p¼0.65).CONCLUSIONS: Given its efficacy and simplicity, a single dose of 500mg of levofloxacin represents an excellent prophylaxis method in transrectal prostate biopsies guided by ultrasound. However, a single dose of amikacin shows similar results as levofloxacin, thus it can significantly reduce the cost of antibacterial therapy and have a similar safety profile.