Early experiences with continent bladder substitution.

Since January 1987 a total of 14 patients have undergone continent bladder replacement procedure. The bladder substitute was constructed of ileum (ileal neobladder) in three patients, of an ileocaecal segment (Mainz pouch) in five patients while in six patients a segment of ascending colon (Mayo pouch) was used. Nine male patients underwent a complete bladder substitution after cystoprostatectomy. In five patients a bladder augmentation was performed. Four of these patients were female. They were subjected to subtotal cystectomy which left only one cm of the bladder neck, while the ureters were reimplanted into the pouch. Seven of the nine patients with total bladder substitution are continent during the day and seven at night. All patients in the bladder augmentation group are continent day and night, but one of them has to empty his bladder by intermittent catheterization. Because of stenosis at the ureterocolonic anastomosis, reoperation was performed on two patients more than one year after the primary operation. Except for these two patients, who required surgical revision, the initial results are encouraging and patient acceptance has been excellent.