PD26-01 EFFECT OF ORAL DDAVP ON NIGHT-TIME INCONTINENCE FOLLOWING OPEN RADICAL CYSTECTOMY AND ORTHOTOPIC URINARY DIVERSION

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I1 Apr 2018PD26-01 EFFECT OF ORAL DDAVP ON NIGHT-TIME INCONTINENCE FOLLOWING OPEN RADICAL CYSTECTOMY AND ORTHOTOPIC URINARY DIVERSION Soroush Bazargani, Zhoobin Bateni, Thomas Clifford, Kevin Wayne, Jie Cai, Gus Miranda, Hooman Djaladat, Anne Schuckman, and Siamak Daneshmand Soroush BazarganiSoroush Bazargani More articles by this author , Zhoobin BateniZhoobin Bateni More articles by this author , Thomas CliffordThomas Clifford More articles by this author , Kevin WayneKevin Wayne More articles by this author , Jie CaiJie Cai More articles by this author , Gus MirandaGus Miranda More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1340AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We evaluated the effect of oral desmopressin (DDAVP) on male patient with persistent nighttime incontinence following orthotopic neobladder (ONB) diversion following radical cystectomy (RC) using validated pad usage questionnaires and in a subgroup who underwent pelvic floor physical therapy (PFPT). METHODS Using our IRB approved database, we identified 1716 patients who underwent open RC from 2002 to 2017. ONB was constructed in 1129 (66%) patients, of whom 964 (86%) were male. Beginning in 2012, patients were prospectively followed, completing a validated, pictorial pad usage questionnaire, assessing the number, size, and wetness of pads, as well as catheter use, at follow up visits. Continence was defined as no pad usage, or pads as “almost dry.” A subgroup of patient with persistent nighttime incontinence after 12 months, were offered oral desmopressin (DDAVP), 0.2-0.4 mg at bedtime. Inclusion criteria were male gender, estimated GFR >50 mL/min/1.73 m2, normal baseline electrolytes and complete daytime urinary continence. Patients were also educated for lifestyle and behavioral modifications including reducing nighttime liquid intake and emptying bladder before going to bed. Patients were followed up with phone calls at 2 and 4 weeks following therapy, and with regular clinic follow-ups thereafter. RESULTS A total of 283 male patients with available pad usage questionnaires were followed from September 2012 to August 2017. 23 patients were eligible for DDAVP treatments with a median age of 71 yrs. There was no significant difference between groups for age, BMI, or Carlson comorbidity index. Median time from cystectomy to treatment was 25 months. 10 patients were excluded from the study (5 never started treatment, 4 went into retention and started CIC, and one developed an allergic reaction). After completion of follow up, out of the 12 who entered the study, 10 patients reported a decrease in urine production, 8 reported a decrease in the number of pads used during nighttime and 7 achieved full nighttime continence. The number of patients who reached nighttime continence was statistically significant compared to baseline (7 out of 12(59%); P = 0.009). 3 patients increased the dose from 0.2 to 0.4 mg after first follow up, one of whom was still unresponsive. Two complications were recorded during the study period, one allergic skin reaction (rash; medication discontinued) and one diarrhea (resolved with continuation of therapy). CONCLUSIONS DDAVP significantly improved nighttime continence. A larger sample size or randomized trial is needed to provide more robust evidence to support the value of DDAVP for nighttime incontinence after RC and ONB. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e551 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Soroush Bazargani More articles by this author Zhoobin Bateni More articles by this author Thomas Clifford More articles by this author Kevin Wayne More articles by this author Jie Cai More articles by this author Gus Miranda More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...