Orthotopic ileal bladder: clinical, urodynamic and metabolic evaluation.

Since January 1985, orthotopic ileal bladder substitution after radical cystectomy was performed in 64 male patients. The Camey I procedure was performed in 35 patients (group 1) and the Studer procedure in 29 (group 2). Clinical, metabolic and urodynamic evaluation was performed at regular intervals with a mean follow-up of 27 months for group 1 and 13.6 months for group 2. Patients with a Camey I bladder reconstruction presented smaller capacity and higher intraluminal pressure resulting in shorter voiding intervals and a practically uniform presence of enuresis, as opposed to those reconstructed with the Studer procedure. The incidence of ureteral reflux was also higher in group 1. Metabolic studies in both groups revealed a slight metabolic acidosis which was treated with oral alkalinization. It is concluded that detubularization of the terminal ileum creates a more favorable low-pressure reservoir.