A CURRENT EXAMINATION OF DIETARY INTAKES OF FIBER, CALCIUM, IRON, AND ZINC AND THEIR RELATIONSHIP TO BLOOD LEAD LEVELS IN U.S. CHILDREN AGED 1-5 YEARS

A CURRENT EXAMINATION OF DIETARY INTAKES OF FIBER, CALCIUM, IRON, AND ZINC AND THEIR RELATIONSHIP TO BLOOD LEAD LEVELS IN U.S. CHILDREN AGED 1-5 YEARS Stephanie Ann Melchert, M.S. University of Nebraska, 2010 Adviser: Kaye Stanek Krogstrand The effect of lead on the health and well-being of those exposed has been well documented and many efforts have been made to reduce exposure of lead to the United States population. Despite these efforts, many studies have documented cognitive impairments and behavioral problems in children with even low levels of lead in their blood. Previous studies have suggested that a proper diet may have a role in the prevention of elevated blood lead levels in children. The objective of this study was to determine if there was an inverse correlation of blood lead levels (BLL) in children to their dietary intakes of fiber, calcium, iron, and zinc considering low levels of lead exposure. This study examined 1019 children in the National Health and Nutrition Examination Survey (NHANES) conducted from 2005-2006. Data were analyzed using Spearman’s rank correlations to correlate continuous variables to BLL in children and independent samples t-tests were used to compare mean blood lead levels of categorical variables. Results indicate that BLL in children is significantly correlated with and weight, recumbent length/standing height, dietary fiber intake and continine, a marker of cigarette smoke exposure. BLL was not significantly correlated with calcium, iron, zinc, or vitamin C. A significant difference was found in the mean BLL of children who took supplements, lived in smoking homes, as well as those who lived in homes built before 1978. Overall, this study shows that children living in homes built before 1978 remain at greater risk for lead exposure, and adequate dietary fiber intake may provide benefits to children who are exposed to lead.

INVESTIGATION INTO CURRENT EFFICIENCY FOR PULSE ELECTROCHEMICAL MACHINING OF NICKEL ALLOY

INVESTIGATION INTO CURRENT EFFICIENCY FOR PULSE ELECTROCHEMICAL MACHINING OF NICKEL ALLOY Yu Zhang, M.S. University of Nebraska, 2010 Adviser: Kamlakar P. Rajurkar Electrochemical machining (ECM) is a nontraditional manufacturing process that can machine difficult-to-cut materials. In ECM, material is removed by controlled electrochemical dissolution of an anodic workpiece in an electrochemical cell. ECM has extensive applications in automotive, petroleum, aerospace, textile, medical, and electronics industries. Improving current efficiency is a challenging task for any electro-physical or electrochemical machining processes. The current efficiency is defined as the ratio of the observed amount of metal dissolved to the theoretical amount predicted from Faraday’s law, for the same specified conditions of electrochemical equivalent, current, etc [1]. In macro ECM, electrolyte conductivity greatly influences the current efficiency of the process. Since there is a certain limit to enhance the conductivity of the electrolyte, a process innovation is needed for further improvement in current efficiency in ECM. Pulse electrochemical machining (PECM) is one such approach in which the electrolyte conductivity is improved by electrolyte flushing in pulse off-time. The aim of this research is to study the influence of major factors on current efficiency in a pulse electrochemical machining process in macro scale and to develop a linear regression model for predicting current efficiency of the process. An in-house designed electrochemical cell was used for machining nickel alloy (ASTM B435) by PECM. The effects of current density, type of electrolyte, and electrolyte flow rate, on current efficiency under different experimental conditions were studied. Results indicated that current efficiency is dependent on electrolyte, electrolyte flow rate, and current density. Linear regression models of current efficiency were compared with twenty new data points graphically and quantitatively. Models developed were close enough to the actual results to be reliable. In addition, an attempt has been made in this work to consider those factors in PECM that have not been investigated in earlier works. This was done by simulating the process by using COMSOL software. However, it was found that the results from this attempt were not substantially different from the earlier reported studies.

Food Handling Practices, Knowledge and Beliefs of Families with Young Children Based on the Health Belief Model

Objective: To determine current food handling practices, knowledge and beliefs of primary food handlers with children 10 years old and the relationship between these components. Design: Surveys were developed based on FightBac!™ concepts and the Health Belief Model (HBM) construct. Participants: The majority of participants (n= 503) were females (67%), Caucasians (80%), aged between 30 to 49 years old (83%), had one or two children (83%), prepared meals all or most of the time (76%) and consumed meals away from home three times or less per week (66%). Analysis: Descriptive statistics and inferential statistics using Spearman’s rank correlation coefficient (rho) (p<0.05 and one-tail) and Chi-square were used to examine frequency and correlations. Results: Few participants reached the food safety objectives of Healthy People 2010 for safe food handling practices (79%). Mixed results were reported for perceived susceptibility. Only half of the participants (53-54%) reported high perceived severity for their children if they contracted food borne illness. Most participants were confident of their food handling practices for their children (91%) and would change their food handling practices if they or their family members previously experienced food poisoning (79%). Participants’ reasons for high self-efficacy were learning from their family and independently acquiring knowledge and skills from the media, internet or job. The three main barriers to safe food handling were insufficient time, lots of distractions and lack of control of the food handling practices of other people in the household. Participants preferred to use food safety information that is easy to understand, has scientific facts, causes feelings of health-threat and has lots of pictures or visuals. Participants demonstrate high levels of knowledge in certain areas of the FightBac!TM concepts but lacked knowledge in other areas. Knowledge and cues to action were most supportive of the HBM construct, while perceived susceptibility was least supportive of the HBM construct. Conclusion: Most participants demonstrate many areas to improve in their food handling practices, knowledge and beliefs. Adviser: Julie A. Albrecht

The South Omaha Community Scholarship Program: A Qualitative Study of Persistence of Hispanic Students at Bellevue University

The purpose of this case study was to determine the impact of the South Omaha Community Scholarship Program on the persistence of the Hispanic students who participated. Previous research on Hispanic student persistence has focused on the reasons why students do not persist and more recent research has been conducted on programs and retention efforts, colleges and universities are implementing on their campuses. This study researched a specific program, The South Omaha Community Scholarship Program, designed to provide financial, academic and other needed resources to help Hispanic students persist to graduation. The researcher believes this study was important because it provided an overview of how the South Omaha Community Scholarship Program is affecting students both on campus and in their community. Eight interviews were conducted, with eligible students, in person. Students eligible for the study were current students or recent graduates of the South Omaha Community Scholarship Program and had attained at least junior or senior status as of the fall of 2009, as defined by Bellevue University. Research questions were based on the four components of the program and the affect the program had on the student’s life, outside of Bellevue University. The four components of the program were: financial aid, academic advising, the scholarship aid, and the Professional Enrichment Program. The results of the study were broken into five components with an additional section that provided other themes that were derived from the interviews. The five components were: (a) financial aid counseling, (b) academic advising, (c) scholarship aid, (d) Professional Enrichment Program, and (e) the South Omaha Community Scholarship Program beyond Bellevue University. Other themes that were derived from the interviews were: class format, deciding on a college, higher education class, campus resources, and a sense of community on-campus. The research found that the scholarship, provided by the South Omaha Community Scholarship Program, was the primary motivating factor for students to attend Bellevue University and persist in college. The interviewed students also commented on how the scholarship had given them the opportunity to attend college, even though that opportunity had seemed out of reach. The interviewed students also commented on their academic advising experience, campus resources, and feeling a sense of community on-campus as other campus related areas that were affected by the South Omaha Community Scholarship Program. Finally, students provided examples of how the South Omaha Community Scholarship Program impacted their connection to their South Omaha community through volunteer and employment opportunities. Adviser: Richard Hoover

Physiological Studies on Candida albicans

Candida albicans is a common opportunistic, dimorphic human fungal pathogen. One of its virulence factors is the morphological switch between yeasts and hyphal or pseudohyphal forms, which can invade tissues and cause damage. Our studies focus on factors regulating pseudohyphae and epigenetic modifications of C. albicans. Regulating factors of pseudohyphae are aromatic alcohols and high phosphate. At low concentrations, exogenous aromatic alcohols induced pseudohyphae, as did high phosphate. For addressing the pathways involved in inducing pseudohyphae by aromatic alcohols or high phosphate, we used mutants defective in cAMP dependent PKA pathway (efg1/efg1), MAP kinase pathway (cph1/cph1), or both (cph1/cph1/efg1/efg1). These mutants failed to produce either hyphae or pseudohyphae in the presence of aromatic alcohols; but high phosphate still stimulated pseudohyphae. Gcn4, a transcription activator of more than 500 amino acid related genes, is turned-on in response to amino acid starvation. The accumulation of aromatic alcohols sends nitrogen starvation signals, which inhibit eIF2B, which in turn derepresses Gcn4p. High phosphate also induces pseudohyphae by derepressing Gcn4p, although the pathways involved are still unknown. In sum, aromatic alcohols and high phosphate induce pseudohyphae by derepressing Gcn4. In this study we found a novel posttranslational histone modification in C. albicans, which is biotinylation. Western blot and Mass spectrometry techniques were used to find that Histones H2B and H4 were biotinylated at every condition tested such as yeast vs. hyphae, aerobic growth vs. anaerobic growth, rich medium vs. defined medium. In C. albicans lysines K8, K11 in histone H4 and lysines K17, K18, K31 in histone H2B are biotin attachment sites as found using mass spectrometry. Biotin was also found to enhance the germ tube formation of C. albicans. Germ tube formation assays with biotin-starved cells as inoculum showed low percent of germ tubes (1-5%). Addition of biotin to the media showed 100% germ tubes. Biotinylation of histones were not detected from biotin-starved cells. Appendix-A details work related to Farnesol quantification assays in several strains of C.albicans and Ceratocystis ulmi, and growth studies of class E VPS strains of Saccharomyces Cerevisiae. Adviser: Kenneth W. Nickerson

Student and Faculty Perceptions of Technology’s Usefulness in Community College General Education Courses

Educational institutions of all levels invest large amounts of time and resources into instructional technology, with the goal of enhancing the educational effectiveness of the learning environment. The decisions made by instructors and institutions regarding the implementation of technology are guided by perceptions of usefulness held by those who are in control. The primary objective of this mixed methods study was to examine the student and faculty perceptions of technology being used in general education courses at a community college. This study builds upon and challenges the assertions of writers such as Prensky (2001a, 2001b) and Tapscott (1998) who claim that a vast difference in technology perception exists between generational groups, resulting in a diminished usefulness of technology in instruction. In this study, data were gathered through student surveys and interviews, and through faculty surveys and interviews. Analysis of the data used Kendall’s Tau test for correlation between various student and faculty variables in various groupings, and also typological analysis of the transcribed interview data. The analysis of the quantitative data revealed no relationship between age and perception of technology’s usefulness. A positive relationship was found to exist between the perception of the frequency of technology use and the perception of technology’s effectiveness, suggesting that both faculty members and students believed that the more technology is used, the more useful it is in instruction. The analysis of the qualitative data revealed that both faculty and students perceive technology to be useful, and that the most significant barriers to technology’s usefulness include faulty hardware and software systems,lack of user support, and lack of training for faculty. The results of the study suggest that the differences in perception of technology between generations that are proposed by Prensky may not exist when comparing adults from the younger generation with adults from the older generation. Further, the study suggests that institutions continue to invest in instructional technology, with a focus on high levels of support and training for faculty, and more universal availability of specific technologies, including web access, in class video, and presentation software. Adviser: Ronald Joekel

The People's Hour and the Social Gospel: George Howard Gibson's Gilded Age Search for an Organization of the Kingdom of God

Previous studies of the Social Gospel movement have acknowledged the fact that Social Gospelers were involved in multiple social reform movements during the Gilded Age and into the Progressive Era. However, most of these studies have failed to explain how the reform experiences of the Social Gospelers contributed to the development of the Social Gospel. The Social Gospelers’ ideas regarding the need to transform society and their strategies for doing so were largely a result of their personal experiences as reformers and their collaboration with other reformers. The knowledge and insight gained from interaction with a variety of reform methods played a vital role in the development of the ideology and theology of the Social Gospel. George Howard Gibson is exemplary of the connections between the Social Gospel movement and several other social reform movements of the time. He was involved in the Temperance movement, was a member of both the Prohibition Party and the People’s Party, and co-founded a Christian socialist cooperative colony. His writings illustrate the formation of his identity as a Social Gospeler as well as his attempts to find an organization through which to realize the kingdom of God on earth. Failure to achieve the changes he desired via prohibition encouraged him to broaden his reform goals. Like many Midwestern Social Gospelers Gibson believed he had found “God’s Party” in the People’s Party, but he rejected reform via the political system once the Populists restricted their attention to the silver issue and fused with the Democratic Party. Yet his involvement with the People’s Party demonstrates the attraction many Social Gospelers had to the reforms proposed in the Omaha Platform of 1892 as well as to the party’s use of revivalistic language and emphasis on producerism and brotherhood. Gibson’s experimentation with a variety of ways to achieve the kingdom of God on earth provides new insight into the experiences and contributions of lay Social Gospelers. Adviser: Kenneth J. Winkle

IMMIGRATION, THE AMERICAN WEST, AND THE TWENTIETH CENTURY: GERMAN FROM RUSSIA, OMAHA INDIAN, AND VIETNAMESE-URBAN VILLAGERS IN LINCOLN, NEBRASKA

The North American West is a culturally and geographically diverse region that has long been a beacon for successive waves of human immigration and migration. A case in point, the population of Lincoln, Nebraska -- a capital city on the eastern cusp of the Great Plains -- was augmented during the twentieth century by significant influxes of Germans from Russia, Omaha Indians, and Vietnamese. Arriving in clusters beginning in 1876, 1941, and 1975 respectively, these newcomers were generally set in motion by dismal economic, social, or political situations in their sending nations. Seeking better lives, they entered a mainstream milieu dominated by native-born Americans -- most part of a lateral migration from Iowa, Illinois, and Pennsylvania -- who only established their local community in 1867. While this mainstream welcomed their labor, it often eschewed the behaviors and cultural practices ethnic peoples brought with them. Aware but not overly concerned about these prejudices, all three groups constructed or organized distinct urban villages. The physical forms of these enclaves ranged from homogeneous neighborhoods to tight assemblies of relatives, but each suited a shared preference for living among kinspeople. These urban villages also served as stable anchors for unique peoples who were intent on maintaining aspects of their imported cultural identities. Never willing to assimilate to mainstream norms, urban villagers began adapting to their new milieus. While ethnic identity constructions in Lincoln proved remarkably enduring, they were also amazingly flexible. In fact, each subject group constantly negotiated their identities in response to interactions among particular, cosmopolitan, and transnational forces. Particularism refers largely to the beliefs, behaviors, and organizational patterns urban villagers imported from their old milieus. Cosmopolitan influences emanated from outside the ethnic groups and were dictated largely but not exclusively by the mainstream. Transnationalism is best defined as persistent, intense contact across international boundaries. These influences were important as the particularism of dispersed peoples was often reinforced by contact with sending cultures. Adviser: John. R. Wunder

Bach-Busoni Chaconne: A Piano Transcription Analysis

In 1893 Ferruccio Busoni transcribed, for the piano, the famous Bach Chaconne for violin solo from the Partita No.2 in D minor. Numerous transcriptions of this piece for different various instruments exist; however Busoni's transcription stands above all others. The purpose of this study was to analyze what the famous, twentieth-century pianist did when he transcribed Bach's Chaconne. What information exists on the topic comes primarily from pianists who dared to learn this exceptionally difficult, beautiful composition. Busoni's accomplishments lie in the new concept, a conceptual transcription, which has two roots: understanding how, historically, we are connected to the music, and how once genres have a special meaning in the twentieth-century. Every generation of musicians brings their own specific point of view and interpretation. Busoni lived on the border of the two centuries and, in his transcription, reveled in several issues overlooked by the previous generation. With his keen understanding of the piece, Busoni highlighted many different genres present in the music, thus allowing recognition of the last movement of the Partita No. 2 in D minor as a Requiem for Bach's wife. By underscoring the genres, Busoni used them as strata. The idea of strata comes from the aesthetics of “play,” and from a different approach to the quality of sound on piano originally intended for a high string instrument. Busoni's arrangement of the texture added both orchestral quality and stereophonic perception. The strata add to a certain reading of Bach's original. Busoni promoted a dramatic approach opening the possibility of reading the chaconne as a multi-layered form. Through Busoni', we see the possibility not only of a tripartite, variation form, but also a composition, with the elements of a concerto, and a sonata. Who could imagine, that a composition written by a young composer at the fin de siecle, intended for practical use by pianists, would subtly influence so many contemporaries and generations, that they will find his findings and music inspiring. Adviser: Dr. Mark K. Clinton

Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial

Erectile dysfunction (ED) and urinary incontinence are common complications following radical prostatectomy (RP). Although pelvic-floor biofeedback training (PFBT) may improve urinary continence following RP, its effects on the recovery of potency are unknown. Fifty-two patients selected for RP were prospectively randomized for a treatment group (n=26) receiving PFBT once a week for 3 months and home exercises or a control group (n=26), in which patients received verbal instructions to contract the pelvic floor. Erectile function (EF) was evaluated with the International Index of Erectile Function-5 (IIEF-5) before surgery and 1, 3, 6 and 12 months postoperatively. Patients were considered potent when they had a total IIEF-5 score >20. Continence status was assessed and defined as the use of no pads. Groups were comparable in terms of age, body mass index, diabetes, pathological tumor stage and neurovascular bundle preservation. A significant reduction in IIEF-5 scores was observed after surgery in both groups. In the treatment group, 8 (47.1%) patients recovered potency 12 months postoperatively, as opposed to 2 (12.5%) in the control group (P=0.032). The absolute risk reduction was 34.6% (95% confidence interval (CI): 3.8-64%) and the number needed to treat was 3 (95% CI: 1.5-17.2). A strong association between recovery of potency and urinary continence was observed, with continent patients having a 5.4 higher chance of being potent (P=0.04). Early PFBT appears to have a significant impact on the recovery of EF after RP. Urinary continence status was a good indicator of EF recovery, with continent patients having a higher chance of being potent.

Perineal rectosigmoidectomy on treatment of rectal procidentia: analysis of 48 cases

OBJECTIVE: To evaluate results obtained in 48 cases of perineal rectosigmoidectomy in patients with rectal procidentia. METHODS: 48 medical records of patients undergoing PRS were analyzed, retrospectively. RESULTS: Before surgery, 44 patients (77.1%) reported complaints of anal mass and rectal bleeding was reported 13 times (22.8%). The period of hospitalization was 3.91 days (2 to 12 days). Women were the majority (85.4%). The mean age was 73.8 years (49 to 101 years). The average time of surgery was 72 minutes (40 to 90 minutes). Mechanical anastomosis was performed in 72.9% and manual in 27.1%. Among the 12 (25%) patients with fecal incontinence, continence was achieved in 2 cases. Postoperative complications occurred in five cases - 10.5% (two pneumonia and three anastomotic leakages). Recurrence was verified in four patients (8,3%). There were no deaths related to the procedure. CONCLUSION: Perineal rectosigmoidectomy is a good surgical option for rectal procidentia, with low morbidity and mortality, low recurrence rate and short hospitalization length.

Fistole retto-vaginali Crohn-relate trattate mediante trasposizione del muscolo gracile: risultati a lungo termine e qualità della vita

OBIETTIVO: Le fistole retto-vaginali Crohn-relate hanno un impatto significativo sulla qualità della vita. Quando il canale anale è alterato da ulcerazioni e stenosi o in pazienti con difetti estesi del perineo, la chirurgia locale produce risultati insoddisfacenti. Lo scopo di questo studio è quello di valutare l'efficacia della trasposizione del muscolo gracile nelle fistole retto-vaginali Crohn-relate e determinare i suoi effetti sulla qualità della vita. MATERIALI E METODI: Da gennaio 2012 a ottobre 2014 sono state trattate 10 pazienti; sono state raccolte alcune variabili (età, BMI, il fumo, CDAI, setone perioperatorio, precedenti procedure, uso di immunomodulatori e steroidi). Tutte le pazienti sono state sottoposte ad ileostomia temporanea prima della graciloplastica. La percentuale di successo è stata misurata come numero di pazienti con fistola guarita dopo la chiusura della stomia. Sono stati utilizzati tre questionari prima della graciloplastica e 3 mesi dopo la chiusura della stomia al fine di valutare la qualità della vita (SF-36), l’ incontinenza fecale e la funzione sessuale. RISULTATI: La fistola retto-vaginale è stata chiusa in 9 pazienti su 10 dopo graciloplastica, con un follow-up medio di chiusura della stomia di 19 mesi (range 4 -34). È stata documentata una recidiva di RVF. Il tempo operatorio era 90-150 minuti (media, 120). La degenza postoperatoria era 7-16 giorni (media 10). Complicanze postoperatorie precoci includevano deiscenza delle suture perineali in 2 casi. Le complicanze a lungo termine includevano disestesia della cicatrice perineale. Nei dati post-operatori abbiamo riportato un miglioramento della qualità di vita, della funzione sessuale e della continenza fecale. CONCLUSIONI: La chiusura della fistola retto-vaginale utilizzando la trasposizione del muscolo gracile è associata a morbidità minima e un alto tasso di successo.

Delirium upon admission to Swiss nursing homes

QUESTIONS UNDER STUDY: We wished to investigate the prevalence of delirium in patients upon admission to nursing homes and whether or not the previous place of residence predicts delirium. METHODS: The Resident Assessment Instrument Minimum Data Set (RAI-MDS) and the Nursing Home Confusion Assessment Method (NHCAM) were used to determine whether the previous place of residence (community, nursing home, acute care, psychiatric, rehabilitation hospital) predicted the prevalence of sub-syndromal or full delirium in nursing home residents in three Swiss cantons (n = 11745). RESULTS: 39.7% had sub-syndromal and 6.5% had full delirium. Lower cognitive performance and increased depressive symptoms were significant predictors of higher NHCAM values independent of previous residence. Age, civil status, continence, newly introduced drugs, and basic activities of daily living were predictors in some resident groups. The variance of NHCAM scores explained varied between 25.1% and 32.3% depending on previous residence. CONCLUSIONS: Sub-syndromal and full delirium are common upon nursing home admission. Increased dependence and depression are consistently associated with higher NHCAM scores. Patients from psychiatric settings have an increased risk of delirium. Although factors associated with delirium depend on a patient's previous residence, all patients must be carefully screened for sub-syndromal and full delirium.

Nerve-sparing open radical retropubic prostatectomy

INTRODUCTION: In recent years, the surgical technique for open radical prostatectomy has evolved and increasing attention is paid to preserving anatomic structures and the impact on outcome and quality of life. METHODS: Technical aspects of nerve-sparing open radical retropubic prostatectomy (RRP) are described. Patient selection criteria and functional results are discussed, focusing on postoperative urinary continence. RESULTS: The video demonstrates the nerve-sparing open RRP and important steps are elucidated with schematic drawings. The value of nerve sparing, not only for preserving erectile function, but also for preserving urinary continence is discussed and results from our institution are presented. In our series, urinary incontinence was present in 1 of 71 patients (1%) with attempted bilateral nerve-sparing, 11 of 322 (3%) with attempted unilateral nerve-sparing, or 19 of 139 (14%) without attempted nerve-sparing surgery. In multiple logistic regression analysis, the only statistically significant factor influencing urinary continence after open RRP was attempted nerve sparing (odds ratio, 4.77; 95% confidence interval, 2.18-10.44; p=0.0001). CONCLUSIONS: Nerve-sparing surgery has a significant impact on erectile function and urinary continence and should be performed in all patients provided radical tumour resection is not compromised. For successful nerve preservation we advocate a lateral approach to the prostate to improve visualisation and simplify separation of the neurovascular bundles from the dorsolateral prostatic capsule. Bunching, ligating, and incising Santorini's plexus over the prostate and not over the sphincter ensures a bloodless surgical field. Mucosa-to-mucosa adaptation of the reconstructed bladder neck and the urethra is another important factor to be observed.

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.