S. 45-49 Artificial Urinary

have been several attempts to develop an artificial bladder. To a large extent appropriate results for the use of alloplastic materials have been mentioned in lectures, but have not been published so far. The reason for this was, on the one hand, the lack of development of suitable materials, and on the other a lack of ideas for realistic, active concepts. As a clinical user of bladder substitute systems, urology supports at present, operative processes in which the use of a separated segment of intestine play the main role. Clinical indications for the use of bladder substitutes are shrunken bladders as a result of infection or radiation dammage, or in seldom cases of congenital bladder malformation. The main areas for substitute bladders are tumours of the bladder. There are approximately 18.000 cases of tumours of the bladder each year in Germany alone. Approximately double so many men are affected (12.500 cases) as women (5.100 cases). The number of women affected is rising dramatically, however, most probably due to the fact that the number of women smokers is becoming larger. The radical cystectomy in women, i.e., a continent urinary divertion as a substitute for their own bladder presents a challenge because the female does not have the sphincter muscle that the male has. The bladder is the 4th most frequent localisation of cancer in men, and the 8th most frequent in women. The frequency of the urothel carcinoma in Europe in 1990 was 66.518 (men: 52.213, women: 14.305), corresponding to a frequency of 28,5/100.000 in men and 5,2/100.000 in women. The highest rate of males was recorded in Italy and Spain, whereas in Great Britain and Sweden the highest rate of females was recorded. The lowest rate for men was in Ireland and for women in Luxembourg. In USA approximately 55.000 new cases are recorded each year. Artificial Urinary Diversion System