Which patients with transitional cell carcinoma of the bladder or prostatic urethra are candidates for an orthotopic neobladder?

Abstract

Bladder replacement has become a standard method of urinary diversion in adults undergoing cystectomy. When faced with a treatment decision, the patient and urologist are most comfortable if information is available on short- and long-term possible outcomes of the proposed intervention and on the magnitude of the expected effect. This article presents and discusses absolute and relative contraindications for orthotopic neobladders that may help optimize the clinical results with these procedures. As our own series has progressed, so has our philosophy regarding patients who are candidates for an orthotopic reconstruction. All men who require radical cystectomy as treatment for bladder cancer are initially thought to be appropriate candidates for orthotopic lower urinary tract reconstruction. Given the criteria presented in this article approximately, 80% of men are considered acceptable candidates for a neobladder. By these criteria, 65% of women are adequate candidates for an orthotopic bladder.