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Introduction and Objectives: Bladder cancer is characterized by gender-dependent disparities. To further address this issue, we analysed a prospective, multicentre cystectomy registry., Methods: An online database was developed that included patient demographics, intra/perioperative data, surgical data and in-house complications., Results: Four hundred fifty-eight patients (112 [24.5%] women and 346 [75.5%] men) were analysed. Men and women were comparable regarding age (mean 68 years), body mass index (mean 26.5) and the mean Charlson score (4.8). Women had more advanced tumour-stages (pT3/pT4; women: 57.1%; men: 48.1%). The rate of incontinent urinary diversion was higher in women (83.1%) than in men (60.2%) and in a multivariate analysis, the strongest predictors were M+ status (OR 11.2), female gender (OR 6.9) and age (OR 6.5). Women had a higher intraoperative blood transfusion rate. The overall rate of in-house complications was similar in both genders (men: 32.0%, women: 32.6%). Severe (Clavien-Dindo grade >2) medical (women: 6.3%; men: 5.2%) and surgical (women: 21.5%; men: 14.4%) in-house complications, however, were more frequent in women., Conclusions: This multicentre registry demonstrates several gender-related differences in patients undergoing radical cystectomy. The higher transfusion rate, the rare use of orthotopic bladder substitutes and the higher in-house complication rate underline the higher complexity of this procedure in women., (© 2017 S. Karger AG, Basel.)

In 19 patients with bladder cancer who required cystectomy, an orthotopic ileal bladder was created. The patients were followed up for an average of 36 months (12-60 months). In this study we present the early and late postoperative complications, the survival data, quality of life assessment, data from urodynamic investigations, metabolic changes and the situation in the upper tracts. Postoperative complications requiring reoperation occurred in 11% in the early postoperative and in 27.7% in the late postoperative phase. Two of 19 patients died from cancer 18 and 26 months after cystectomy. A further patient had an urethral recurrence and the cancer is progressing further. Questionnaires showed that 80% of our patients were satisfied with their new bladder. Eighty percent were continent during the day and at night. Stress incontinence (II-III) occurred in only 2 patients (12%). All patients were impotent, but in 5 SCAT therapy made intercourse possible. The metabolic acidosis required oral alkalization in 60%. Dilatation of the upper urinary tract was seen in 6% of the renal units. We conclude from our experience that an orthotopic ileal neobladder is an excellent method of urinary diversion after cystectomy.

In an attempt to elucidate factors predisposing to the occurrence of urethral stricture after transurethral resection of the prostate, we performed a prospective follow-up of 178 patients over 12-20 months. We took account of 11 factors that we considered important. Urethral strictures developed in 14.04% of the patients. The resection operations were carried out by five different surgeons, who had different rates of stricture. The only one of the 11 factors studied that was found to involve a statistically significant risk was the presence of an indwelling catheter for more than 3 days. No other factor influenced the result. This patient group was compared with a group of 73 patients followed up for 12-60 months following transvesical prostatectomy. In this group only one stricture (1.36% incidence rate) was observed retrospectively. It seems that urethral ischaemia might increase the risk of urethral stricture. Urethral injuries are considerably less frequent with open prostatectomy. Therefore, we recommend transvesical prostatectomy for pronounced prostatic hyperplasias.