Background: Orthotopic bladder reconstruction is the preferred method of urinary diversionfollowing radical cystectomy (RC). Several papers reported functional data of different orthotopicneobladders, although to date, no one has used validated questionnaires.Objective: To evaluate the midterm functional results in a contemporary series of patientsundergoing RC and vescica ileale Padovana (VIP) orthotopic neobladder by applying a set ofvalidated questionnaires.Design, setting, and participants: We conducted a cross-sectional study at a single academiccentre.Intervention: We included RC and VIP orthotopic techniques for bladder transitional cellcarcinoma.Measurements: The American Urological Association Symptom Index (AUA-SI), the InternationalConsultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UISF), and the five-item version of the International Index of Erectile Function (IIEF-5) were usedto evaluate functional outcomes.Results and limitations: All 113 patients who were alive and disease free at 44-mo follow-upwere evaluated. Sixteen patients (13%) were on clean intermittent catheterisation (CIC). Themedian AUA-SI score of the 97 voiding patients was 9 (interquartile range [IQR]: 4.5–16).Specifically, 48.5%, 40.2%, and 11.3% of the patients had mild, moderate, or severe lower urinarytract symptoms (LUTS), respectively. American Society of Anaesthesiologists class (odds ratio[OR]: 9.0; p = 0.03) and body mass index (OR: 1.5; p = 0.023) were independent predictors of theneed for CIC, while only patient age at the time of surgery (OR: 0.920; p = 0.01) was predictive ofLUTS severity. The median ICIQ-UI SF score was 6 (IQR: 3–10). Twenty patients (17.7%) werefully continent, while 31.9%, 35.4%, and 15% had slight, moderate, and severe incontinence,respectively. About 90% of the patients during the day and 80% during the night used no pad oronly a safety pad. Most of the patients leaked when asleep. No variable was predictive of returnto continence. Finally, roughly 20% of the male patients were potent, having an IIEF-5 score17.Conclusions: We reported midterm functional outcomes following RC and VIP neobladderusing validated questionnaires. On the whole, the results are encouraging. However, in theabsence of patient self-completed questionnaires, functional outcomes may be significantly overestimated.
Functional results following vescica ileale Padovana (VIP) neobladder: midterm follow-up analysis with validated questionnaires.
ARTIBANI, Walter
2010-01-01
Abstract
Background: Orthotopic bladder reconstruction is the preferred method of urinary diversionfollowing radical cystectomy (RC). Several papers reported functional data of different orthotopicneobladders, although to date, no one has used validated questionnaires.Objective: To evaluate the midterm functional results in a contemporary series of patientsundergoing RC and vescica ileale Padovana (VIP) orthotopic neobladder by applying a set ofvalidated questionnaires.Design, setting, and participants: We conducted a cross-sectional study at a single academiccentre.Intervention: We included RC and VIP orthotopic techniques for bladder transitional cellcarcinoma.Measurements: The American Urological Association Symptom Index (AUA-SI), the InternationalConsultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UISF), and the five-item version of the International Index of Erectile Function (IIEF-5) were usedto evaluate functional outcomes.Results and limitations: All 113 patients who were alive and disease free at 44-mo follow-upwere evaluated. Sixteen patients (13%) were on clean intermittent catheterisation (CIC). Themedian AUA-SI score of the 97 voiding patients was 9 (interquartile range [IQR]: 4.5–16).Specifically, 48.5%, 40.2%, and 11.3% of the patients had mild, moderate, or severe lower urinarytract symptoms (LUTS), respectively. American Society of Anaesthesiologists class (odds ratio[OR]: 9.0; p = 0.03) and body mass index (OR: 1.5; p = 0.023) were independent predictors of theneed for CIC, while only patient age at the time of surgery (OR: 0.920; p = 0.01) was predictive ofLUTS severity. The median ICIQ-UI SF score was 6 (IQR: 3–10). Twenty patients (17.7%) werefully continent, while 31.9%, 35.4%, and 15% had slight, moderate, and severe incontinence,respectively. About 90% of the patients during the day and 80% during the night used no pad oronly a safety pad. Most of the patients leaked when asleep. No variable was predictive of returnto continence. Finally, roughly 20% of the male patients were potent, having an IIEF-5 score17.Conclusions: We reported midterm functional outcomes following RC and VIP neobladderusing validated questionnaires. On the whole, the results are encouraging. However, in theabsence of patient self-completed questionnaires, functional outcomes may be significantly overestimated.
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