Orthotopic bladder substitution “I first started to think about orthotopic bladder substitution in 1983, when I saw the deadly complications arising from the use of continent reservoirs. Patients were unable to catheterise themselves and died overnight from septicemia. The idea of an intestinal bladder substitute was not new, it had been tried many times in urological history. What was new was the avoidance of incontinence caused by the tubular reservoirs. I tried a low-pressure reservoir which does not have high pressure spikes due to intestinal contractions. I used the principal which was developed by Dr. Goodwin for bladder augmentation procedures,” said Studer. “The results from animal studies were presented for the first time at the Annual EAU Congress in Budapest in 1986, which resulted in a great deal of opposition. I was glad to get out of the audience alive!” said Studer. “The first paper on the subject which was submitted to the Journal of Urology was rejected because the reviewers said it was nothing new. As it turned out, one of the reviewers presented his own ‘new’ technique a few months later,” added Studer with an amused look.