Clin Oncol | Volume 7, Issue 1 | Research Article | Open Access

The Evolution of Orthotopic Bladder Substitution: Faults and Fixes

Richard E Hautmann*

Department of Urology, University of Ulm, Germany

*Correspondance to: Richard E Hautmann 

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Background: Much more patients qualify for Orthotopic Bladder Substitution (OBS) than actually get it. One major reason is the unguaranteed continence outcome.
Objective: Understanding the evolution of OBS and to analyze faults why these process spans 100 years from the idea of Tizzoni and Foggi in 1888 to a standard surgical procedure with acceptable continence. Design, Setting, and Participants: The author’s comprehensive OBS registry was reviewed. For the first part of the analysis from 1888 till 1987 any report on OBS has been analyzed, later only sizable series that stood the test of time.
Results and Limitations: The faults of Tizzoni and Foggi published promising preliminary results and withheld disastrous long-term outcomes. Their excellent results must be attributed to the regenerated bladder rather, than bladder substitution. The tubular segment then became a diverticulum. Two negative consequences resulted. First, for 100 years surgeons have repeated
the faulty set up of a tubular reservoir. Secondly, numerous patients were rendered incontinent. Detubularization and cross-folding of the ileum were published in 1899 and 1953, respectively; however, they had gone unrecognized until 1987.
Conclusion: Since the 18th century the goal of urinary diversion has been to replace bladders. The evolution of OBS demonstrated a discrepancy between surgical ambition and disappointing continence outcomes. A sloppy literature search and faulty experimental setup have resulted in imperfect techniques. Techniques including perfect detubularization and cross folding provide reproducible continence results and have stood the test of time. Recently unsatisfactory reservoirs are increasingly used to speed up the operation. It is important that we learn from the past and not make the same mistakes in the future.
Patient Summary: Following removal of the bladder urinary diversion is required. The standard incontinent diversion with stoma and bag as well as OBS uses a gut segment. The complicated evolution of the neobladder is presented.


Urinary diversion; Orthotopic reconstruction; Evolution; Detubularization; Cross folding


Hautmann RE. The Evolution of Orthotopic Bladder Substitution: Faults and Fixes. Clin Oncol. 2022;7:1938..

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