PD41-01 URODYNAMIC EVALUATION IN WOMEN UNDERGOING RADICAL CYSTECTOMY AND ORTHOTOPIC NEOBLADDER: PRE- AND POSTOPERATIVE ROLES

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (PD41)1 Apr 2020PD41-01 URODYNAMIC EVALUATION IN WOMEN UNDERGOING RADICAL CYSTECTOMY AND ORTHOTOPIC NEOBLADDER: PRE- AND POSTOPERATIVE ROLES Bedeir Ali-El-Dein*, Ahmed Elhefnawy, Mohamed H Zahran, Atallah A Shaaban, and Mohamed A Ghoneim Bedeir Ali-El-Dein*Bedeir Ali-El-Dein* More articles by this author , Ahmed ElhefnawyAhmed Elhefnawy More articles by this author , Mohamed H ZahranMohamed H Zahran More articles by this author , Atallah A ShaabanAtallah A Shaaban More articles by this author , and Mohamed A GhoneimMohamed A Ghoneim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000921.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To investigate the role of urodynamic evaluation preoperatively and postoperatively to characterize and plan treatment of voiding and continence problems in women undergoing radical cystectomy (RC) and orthotopic neobladder (ONB). METHODS: Between January 1995 and December 2018, RC and ONB were performed in 395 women with bladder cancer (BC) and a mean age of 53 + 10 years. Of these, genitalia sparing cystectomy was performed in 25. Preoperatively, only urethral pressure profile (UPP) was conducted. Postoperatively, evaluation included voiding and continence outcome using UPP, water cystometry of the pouch, voiding pouchometry, leak point pressure (LPP) and pelvic floor electromyography (EMG). Preoperative UPP was correlated with postoperative voiding and continence outcome and we used urodynamic data to plan treatment of postoperative voiding and continence problems. RESULTS: 125 urodynamically evaluated patients were eligible with a median followup of 93 months. The mean preoperative maximal urethral closing pressure (MUCP) was 70 ± 19 cm.water, mean functional urethral length (FUL) was 30.2 ± 4.5 mm and mean continence product (CP) was 2114 cm.water mm. There was no correlation between these values and postoperative continence and voiding status. Of these patients, 64 (51%) were totally continent, 3 (2.4%) had total incontinence (TI), 9 stress urinary incontinence (SUI), 30 (24%) isolated nighttime incontinence (NI), and 7 (5.6%) had NI on top of chronic urinary retention (CUR). CUR developed in 38 patients (30%), including 7 with NI and 2 with TI. Among NI patients, 18 had pouch hyperactivity, 7 had CUR, 6 had incompetent urethral closure mechanism (IUCM), 19 had UTI, while 6 had no reason. Patients with NI and IUCM (6) and those with TI (3) had marked decrease of the mean MUCP (69 vs 38.4), mean FUL (30 vs 22) and mean CP (2070 vs 845) compared with preoperative values (p<0.001). Changes of the UPP values over time (at 6 and 60 months) in 50 patients were not predictive of changes of the continence or voiding status. On filling cystometry, pouch hyperactivity was noted in 18 women with NI, 5 with NI on top of CUR and 16 (13%) continent women (p = 0.038). EMG on 16 patients with CUR showed silent pelvic floor. Based on these data, NI was treated by imipramine hydrochloride 50 mg at bed time, anticholinergics and antimicrobial treatment for positive cultures with improvement in 22 patients. CUR was successfully treated by CIC and anticholinergics (pouch hyperactivity). CONCLUSIONS: UPP is a helpful objective tool to assess the urethral closure mechanism before and after RC and ONB in women. In the studied cohort, postoperative changes of the UPP parameters over time were not predictive of changes of the voiding or continence status. Urodynamic evaluation helps characterize and plan treatment of voiding and continence problems after ONB. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e821-e821 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bedeir Ali-El-Dein* More articles by this author Ahmed Elhefnawy More articles by this author Mohamed H Zahran More articles by this author Atallah A Shaaban More articles by this author Mohamed A Ghoneim More articles by this author Expand All Advertisement PDF downloadLoading ...