Twenty years experience with an ileal orthotopic low pressure bladder substitute--lessons to be learned

PURPOSE: We present the long-term results of a large consecutive series of patients undergoing ileal orthotopic bladder substitution following radical cystectomy. MATERIALS AND METHODS: Between April 1985 and 2005 orthotopic bladder substitution with an ileal low pressure reservoir was performed in 482 patients (including 40 women) after radical and, if possible, nerve sparing cystectomy. In 447 cases the procedure was combined with an afferent ileal isoperistaltic tubular segment. The patients were followed prospectively. RESULTS: In the 482 patients 61 early (less than 30 days) diversion related complications requiring prolonged hospital stay or readmission were noted and 115 late complications required treatment. At 1 year continence was good in 92% of patients during the day and in 79% at night. At last followup 93% of patients could void spontaneously. Of 442 evaluable men 99 (22.4%) reported having erections without and 68 (15.4%) with medical assistance. Ureteroileal stenosis was observed in 12 of 447 (2.7%) patients. Urethral recurrence was detected in 25 of 482 (5%) patients. A total of 15 (5%) patients received vitamin B12 substitution. Renal parenchyma decreased only in patients with preoperative or postoperative ureteral obstruction. After 10 years patients with normal renal function had no long-term acidosis and in 20 patients the incidence of osteoporosis resembled that of the normal population. CONCLUSIONS: Ileal orthotopic bladder substitution combined with an afferent ileal tubular segment allows for good long-term functional results provided patients are restrictively selected, postoperative instructions are followed carefully, and typical complications such as outlet obstruction and hernias are treated early.

Lessons Learned from 'Hall of Socialism': Juxtaposing Finnish-American Radicalism with Today's Protest Movements

Historical accounts of revolutionary movements oftentimes occlude the pleasures of countering hegemony or criticize the “frivolity” of what is perceived to be non-political activities. However, turn of the century Finnish-American socialist theater clubs and early twentieth century Finnish-American communist halls and their uncounted social groups and activities prove to be a rich resource in reconsidering the importance of acknowledging and understanding the role that pleasure has played and should play in political protest. Finnish-American radical activities, especially those condemned already at the time as hall socialism, are important historical precedents to today’s alter-globalization student festivals and protest concerts, midnight raves

Lessons from Two Decades of Hanta Virus Research

Dr. Richard J. Douglass has been conducting small mammal field studies since 1968. For the past 19 years he has been conducting field studies on the ecology of deer mice and hantavirus in Montana, Panama, and Argentina. He has published papers on mammals from rodents to large ungulates. He has been conducting student field trips at Montana Tech since 1983.

Strategies for the Next Generation of Conservation: Lessons from a Life in Environmental Leadership

Successful leadership in the conservation community depends upon leaders with a vision who can engage collaborators in a transaction to create something of enduring value. Ideally, results are achieved in a win-win fashion with other stakeholders. However, a good leader must employ a broader range of tools.

Tracking Montana’s Groundwater: 20 Years of Lessons Learned

Long-term water-level measurements provide a fundamental indicator of the health of Montana's groundwater resources. For more than 20 years the Groundwater Assessment Program has monitored groundwater levels across the state. This lecture reviews the State's groundwater use and shows how climate variability, groundwater development, and land-use has impacted different aquifers.