Daytime Continence Research Articles

Effect of overnight bladder drainage on posterior urethral valve sequelae: A randomized controlled trial

Posterior urethral valves may lead to persistent hydronephrosis (HN) and bladder dysfunction despite successful endoscopic valve ablation (EVA). To evaluate the effect of overnight bladder drainage (OBD) on upper urinary tracts and bladders of boys post EVA. Boys who had persistent HN after EVA were included. Patients were randomly allocated into OBD or no OBD groups. Timed voiding, anticholinergics and antibiotic prophylaxis were offered for both groups. After 12 months, patients were evaluated for compliance to OBD, daytime continence, febrile urinary tract infections (UTIs), renal function by serum creatinine and 99mTc-dimercaptosuccinic acid scan, HN, vesicoureteral reflux (VUR) and bladder morphology assessed by ultrasound and voiding cystourethrogram. Ninety-nine patients; 47 underwent OBD while 52 had no OBD, completed 12 months of follow-up. Compliance to OBD was reported in 87.04%. OBD group showed significant improvement in daytime continence, HN, VUR, bladder capacity and outline. However, febrile UTIs, renal function affection, bladder wall thickness and post-void urine residual were comparable between both groups. OBD might improve daytime continence, HN, VUR and abnormal bladder morphology that persist after EVA with no subsequent febrile UTIs or renal function affection. Yet, compliance to OBD remains a matter of concern.

Cloacal Exstrophy Closure Without Osteotomy and Immobilization: A Recipe for Failure

BackgroundCloacal exstrophy (CE) remains one of the most severe birth defects compatible with life with a constellation of anomalies involving the bladder, genitalia, hindgut, and spinal cord. Pelvic osteotomy and immobilization have been utilized to facilitate bladder closure, yet their role as adjuncts remains a topic of debate. The authors sought to evaluate the outcomes of CE closure without the use of osteotomy or lower extremity (LE)/pelvic immobilization. MethodsAn institutional database of 173 CE patients was reviewed for patients closed without osteotomy and/or limb immobilization. Patient records were reviewed for continence procedures, reclosure operations, and continence outcomes. ResultsA total of 59 closure surgeries that met inclusion criteria were identified in 56 unique patients. Thirty-seven closure procedures developed eventual failure (63%) with secondary closure events also resulting in failure. Most closures did not use an osteotomy, 93.2%. LE immobilization-only was used in most closures (43/59), of which only 37% were successful. Failures were attributed to dehiscence (14/37), bladder prolapse (19/37), or both dehiscence and prolapse (4/37). The median age at closure was 3 days old (1–18.5 IQR) with the majority of closure events (47) closure events taking place in the newborn period. Median diastasis prior to primary closure was 6 cm (4.8–8 cm IQR). The median number of closure attempts needed to close the bladder was 2 (1–2 IQR). Of the 56 patients, 31 have >3 h of daytime continence, with the entirety of these patients catheterizing a stoma or below. ConclusionThese results highlight the critical role of osteotomy and lower limb immobilization in successful closure of the bladder and abdominal wall in CE. Type of StudyTreatment Study. Level of EvidenceLevel III.

Comparative evaluation of reproductive organ-preserving versus standard radical cystectomy in female: a meta-analysis and systematic review of perioperative, oncological, and functional outcomes.

To evaluate the perioperative, oncological, and functional outcomes of reproductive organ-preserving radical cystectomy (ROPRC) compared to standard radical cystectomy (SRC) in the treatment of female bladder cancer. A systematic search was conducted in November 2023 across several scientific databases. We executed a systematic review and cumulative meta-analysis of the primary outcomes of interest, adhering to the PRISMA and AMSTAR guidelines. The study was registered in PROSPERO (CRD42024501522). The meta-analysis included 10 studies with a total of 2015 participants. ROPRC showed a significant reduction in operative time and postoperative fasting period compared to SRC (MD -45.69, 95% CI -78.91 ~ -12.47, p = 0.007, and MD -0.69, 95% CI -1.25 ~ -0.13, p = 0.02, respectively). Functional outcomes, both daytime continence rate (OR 4.94, 95% CI 1.53 ~ 15.91, p = 0.008) and nighttime continence rate (OR 5.91, 95% CI 1.94 ~ 18.01, p = 0.002), and sexual function measured by the Female Sexual Function Index (MD 5.72, 95% CI 0.19 ~ 11.26, p = 0.04), were significantly improved in the ROPRC group. There were no significant differences between ROPRC and SRC in terms of estimated blood loss, length of hospital stay, overall postoperative complications, minor complications or major complications. Oncologically, both procedures showed comparable outcomes with no significant differences in positive surgical margins, tumor recurrence rates, overall survival, cancer-specific survival, recurrence-free survival, or progression-free survival. ROPRC is a viable and effective alternative to SRC in female bladder cancer patients, offering enhanced functional outcomes and similar oncological safety. These findings suggest that ROPRC can improve the quality of life in female bladder cancer patients without compromising the efficacy of cancer treatment.

Urodynamic Parameters and Continence Outcomes in Asymptomatic Patients with Ileal Orthotopic Neobladder: A Systematic Review and Metanalysis.

The orthotopic neobladder is the type of urinary diversion (UD) that most closely resembles the original bladder. However, in the literature the urodynamic aspects are scarcely analysed. To provide the first systematic review (SR) on the urodynamic (UDS) outcomes of the ileal orthotopic neobladders (ONB). Continence outcomes are also presented. A PubMed, Embase and Cochrane CENTRAL search for peer-reviewed studies on ONB published between January 2001-December 2022 was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Fifty-nine manuscripts were eligible for inclusion in this SR. A great heterogeneity of data was encountered. Concerning UDS parameters, the pooled mean was 406.2 mL (95% CI: 378.9-433.4 mL) for maximal (entero)cystometric capacity (MCC) and 21.4 cmH2O (95% CI: 17.5-25.4 cmH2O) for Pressure ONB at MCC. Postvoid-residual ranged between 4.9 and 101.6 mL. The 12-mo rates of day and night-time continence were 84.2% (95% CI: 78.7-89.1%) and 61.7% (95% CI: 51.9-71.1%), respectively.Despite data heterogeneity, the ileal ONB seems to guarantee UDS parameters that resemble those of the native bladder. Although acceptable rates of daytime continence are reported the issue of high rates of night-time incontinence remains unsolved. Adequately designed prospective trials adopting standardised postoperative care, terminology and methods of outcome evaluation as well as of conduction of the UDS in the setting of ONB are necessary to obtain homogeneous follow-up data and to establish UDS guidelines for this setting.

Learning curve for intracorporeal robotic Padua ilealbladder: 10-year functional assessment from a high-volume single-centre series.

To assess the impact of the learning curve (LC) on perioperative and long-term functional outcomes of a consecutive single-centre series of robot-assisted radical cystectomy with Padua intracorporeal orthotopic neobladder. Patients treated between 2013 and 2022 were included, with ≥1 year of follow-up. The entire cohort was divided in tertiles. Categorical and continuous variables were compared. Joinpoint regression analysis was used to identify significant changes over the decade in linear slope of the 1-year day- and night-time continence. Uni- and multivariable Cox regression analyses identified predictors of day- and night-time continence recovery. Day-time continence was defined as 'totally dry' (no pads), night-time continence as pad wetness ≤50 mL (one safety pad). Overall, 200 patients were included. The mean hospital stay (P = 0.002) and 30-day complications (P = 0.04) significantly reduced over time; the LC significantly impacted on Trifecta achievement (P < 0.001). The 1-year day- and night-time continence probabilities displayed a significant improving trend (day-time continence annual average percentage change [AAPC] 11.45%, P < 0.001; night-time continence AAPC 10.05%, P = 0.009). The LC was an independent predictor of day- (hazard ratio [HR] 1.008; P < 0.001) and night-time continence (HR 1.004; P = 0.03) over time. Patients at the beginning of the LC had significantly longer hospitalisations, more postoperative complications, and lower Trifecta rates. At the 10-year analyses, we observed a significant improving trend for both the 1-year day- and night-time continence probabilities, highlighting the crucial role of the LC. However, we are unable to assess the case volume needed to achieve a plateau in terms of day- and night-time continence rates.

Exploring lifelong overactive bladder: Transitions, evidence, and clinical implications; A modified Delphi process.

Overactive bladder (OAB) is a prevalent urological condition characterized by urinary urgency, with or without urgency urinary incontinence, accompanied by increased daytime frequency and nocturia. However, the current definition of OAB lacks a specified time frame, hindering our understanding of the temporal aspects and transitions that occur within the OAB spectrum. A modified Delphi study was conducted in three rounds, involving a panel of international experts in functional urology, urogynaecology, geriatrics, transitional medicine, and pediatric urology. The study took place between February 2023 and June 2023 and employed two sequential rounds of online surveys, followed by a final hybrid group discussion session in June 2023. The Delphi process resulted in a consensus definition of lifelong OAB as a persistent and continuous condition that may manifest differently from birth and evolve over time, with varying levels of clinical perception. The course of its progression is influenced by transition periods and modifying factors, mainly anatomical, hormonal, and psychosocial/stressors. Three main transition periods were identified: achievement of daytime continence, adulthood to elderly, and transition to frail elderly. The panel also considered the therapeutic and diagnostic implications of lifelong OAB, as well as future research prospects in terms of importance and feasibility. Future longitudinal research is needed to develop this concept and further identify transitions and temporal dynamics.

Bladder Neck Surgery is not Routinely Needed to Achieve Urinary Continence in Patients with Primary Epispadias

BackgroundThis study aims at investigating the continence outcome in primary epispadias patients treated at a tertiary center. The authors hypothesized that additional continence procedures following primary epispadias repair is not routinely needed. MethodsPatients treated for primary epispadias at the authors’ institution between 2007 and 2019 and toilet trained, were identified from a prospective maintained database. Males underwent chordee correction, urethroplasty and glanuloplasty. Females underwent genitoplasty with reduction urethroplasty. If continence was not achieved by 4–5 years of age, pelvic floor muscle (PFM) biofeedback therapy was performed. Other continent procedures were discussed with family/patient if still incontinent. Primary outcome: urinary continence. Secondary outcomes: PFM biofeedback therapy, continence surgery, hydronephrosis. Type of epispadias, age at repair and follow-up presented as median was also reported. ResultsThirty-three patients (29 males) were included. Twelve had penopubic epispadias, 13 glanular/penile, 4 duplicated urethra, 4 females. Median age at repair: 2 years (IQR 1–3), at follow-up: 8 years (IQR 6–10). Daytime continence: 100 % in penile/glanular; 33 % in penopubic and 75 % in duplicated urethra. Nighttime continence: respectively 92 %, 50 % and 100 %. 24 % of males were intermittently incontinent. All patients except one voided urethrally. One patient underwent bladder neck closure, ileocystoplasty and Mitrofanoff. One girl achieved daytime continence, 2 were intermittently incontinent, one continuously incontinent. All were enuretic. 38 % of boys and 100 % of girls had biofeedback therapy. None had hydronephrosis/renal impairment. ConclusionsMost children with primary epispadias can achieve social urinary continence spontaneously or with the support of PFM biofeedback therapy. Other continence procedures should be reserved for patients who do not attain satisfactory continence. Level of EvidenceTreatment study – level IV.

Urinary function in female patients after traditional, organ-sparing and nerve-sparing radical cystectomy for bladder cancer: a systematic review and pooled analysis.

To determine and summarize the available data on urinary, sexual, and health-related quality-of-life (HRQOL) outcomes after traditional radical cystectomy (RC), reproductive organ-preserving RC (ROPRC) and nerve-sparing RC (NSRC) for bladder cancer (BCa) in female patients. The PubMed, SCOPUS and Web of Science databases were searched to identify studies reporting functional outcomes in female patients undergoing RC and urinary diversion for the treatment of BCa. The outcomes of interest were voiding function (for orthotopic neobladder [ONB]), sexual function and HRQOL. The following independent variables were derived and included in the meta-analysis: pooled rate of daytime and nighttime continence/incontinence, and intermittent self-catheterization (ISC) rates. Analyses were performed separately for traditional, organ- and/or nerve-sparing surgical approaches. Fifty-three studies comprising 2740 female patients (1201 traditional RC and 1539 organ-/nerve-sparing RC, and 264 nerve-sparing-alone RC) were eligible for qualitative synthesis; 44 studies comprising 2418 female patients were included in the quantitative synthesis. In women with ONB diversion, the pooled rates of daytime continence after traditional RC, ROPRC and NSRC were 75.2%, 79.3% and 71.2%, respectively. The pooled rate of nighttime continence after traditional RC was 59.5%; this rate increased to 70.7% and 71.7% in women who underwent ROPRC and NSRC, respectively. The pooled rate of ISC after traditional RC with ONB diversion in female patients was 27.6% and decreased to 20.6% and 16.8% in patients undergoing ROPRC and NSRC, respectively. The use of different definitions and questionnaires in the assessment of postoperative sexual and HRQOL outcomes did not allow a systematic comparison. Female organ- and nerve-sparing surgical approaches during RC seem to result in improved voiding function. There is a significant need for well-designed studies exploring sexual and HRQOL outcomes to establish evidence-based management strategies to support a shared decision-making process tailored towards patient expectations and satisfaction. Understanding expected functional, sexual and quality-of-life outcomes is necessary to allow individualized pre- and postoperative counselling and care delivery in female patients planned to undergo RC.

Long-term oncologic and functional outcomes following robot-assisted radical cystectomy and intracorporeal Padua ileal bladder: results from a single high-volume center.

To report long-term oncologic and functional outcomes of a large consecutive single center series of Robot-assisted radical cystectomy (RARC)- intracorporeal (IC) Urinary Diversion (UD), identifying their predicting factors. A single center Bladder cancer (BC) database was queried for "RARC" and "ICUD", including patients treated between January 2012 and September 2020. Kaplan-Meier curves were assessed disease-free (DFS), cancer-specific (CSS) and overall survival (OS) probability. Univariable (UV) and multivariable (MV) analysis were adopted to identify predictors of DFS, CSS and OS. Kaplan-Meier method evaluated day- and night-time continence recovery probabilities; UV and MV analysis were adopted to identify predictors of Day-time continence. Overall, 251 patients were included. Among them, 192 patients underwent intracorporeal ileal orthotopic neobladder (ION) (76.5%). Five-year DFS, CSS and OS rates were 66.5%, 65.4% and 61.5%; pT stage ≥ 3 and pathologic nodal involvement were identified as negative independent predictors of DFS (HR 2.39, p = 0.001, HR 4.64, p ≤ 0.001), CSS (HR 2.20, p = 0.01, HR 3.97, p < 0.001) and OS (HR 2.25, p = 0.005, HR 3.95, p < 0.001). In RARC-ION patients, Trifecta rate was 64.1%. One-year day- and night-time continence rates were 78.6% and 48.3%. Age (HR 0.98, p = 0.03), female gender (HR 0.57, p = 0.008) and complications Clavien grade ≥ 3 (HR 0.55, p = 0.03) were identified as independent predictors of day-time incontinence. Long-term oncologic outcomes and their predicting factors seem aligned to the largest historical open series and multi-institutional robotic series data. According to the identified predicting factors undermining a proper achievement of day-time continence, this represents an objective support, in order to properly advice specific sub-group of patients.

Voiding and renal function 10 years after radical cystectomy and orthotopic neobladder in women.

To assess long-term voiding and renal function (RF) changes after radical cystectomy (RC) and orthotopic neobladder (ONB) surgery in women without disease recurrence. Women who underwent RC and ONB reconstruction between 1995 and 2011 were included in this study. Patients who developed disease failure or were lost to follow-up were excluded. The study outcomes were long-term voiding function and the incidence and predictors of RF deterioration (defined as >20% decline of baseline). Analysis was performed using the log-rank test and Cox regression analysis. The study included 195 patients with a median (interquartile range) follow-up of 98 (53-151) months, of whom 95 had >10 years of follow-up. Daytime continence, night-time continence and chronic urine retention (CUR) were identified in 170 (87%), 134 (69%) and 52 patients (27%), respectively. Among patients with >10 years of follow-up, 82 (86%), 66 (70%) and 31 (33%) had daytime continence, night-time continence and CUR at the last follow-up visit, respectively. RF deterioration events occurred in 74 patients throughout the follow-up and chronic kidney disease (CKD) stage III-V developed in 80 patients. Patients' age (hazard ratio [HR] 1.41, 95% confidence interval [CI]1.06-1.89; P = 0.02) and serous-lined extramural tunnel diversion (HR 0.43, 95% CI 0.19-0.86; P = 0.02) were the independent predictors of RF deterioration. Among patients with >10 years of follow-up, RF deteriorated in 46 patients (49%) and CKD stage III-V developed in 40 (42%). Women surviving more than 10 years after RC and ONB maintained acceptable continence status, apart from having a higher CUR rate, compared to those followed for <10 years. However, RF deterioration developed in nearly half of them.

MP32-14 COMPLETELY DRY DAYTIME CONTINENCE AND UNMODIFIED SEXUAL FUNCTION AS KEY ASPECTS OF HEALTH-RELATED QUALITY OF LIFE AFTER RADICAL CYSTECTOMY AND ORTHOTOPIC NEOBLADDER

You have accessJournal of UrologyCME1 Apr 2023MP32-14 COMPLETELY DRY DAYTIME CONTINENCE AND UNMODIFIED SEXUAL FUNCTION AS KEY ASPECTS OF HEALTH-RELATED QUALITY OF LIFE AFTER RADICAL CYSTECTOMY AND ORTHOTOPIC NEOBLADDER Riccardo Mastroianni, Gabriele Tuderti, Umberto Anceschi, Alfredo Maria Bove, Aldo Brassetti, Simone D'annunzio, Mariaconsiglia Ferriero, Leonardo Misuraca, Salvatore Guaglianone, and Giuseppe Simone Riccardo MastroianniRiccardo Mastroianni More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Simone D'annunzioSimone D'annunzio More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003265.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Survival outcomes are primary endpoints of oncologic surgery. However, health-related quality of life (HRQoL) is too often misevaluated. Radical cystectomy (RC) with urinary diversion has a significant impact on HRQoL. In this study, we evaluated predictors of unmodified 2yr-QoL after RC with orthotopic neobladder (ON) from an ongoing randomized controlled trial (RCT) comparing ORC and RARC with intracorporeal (i)-UD. METHODS: Patients were eligible with a cT2-4cN0cM0, or recurrent HG NMIBC and no anesthesiologic contraindications to robotic surgery. Between Jan 2018 and Sept 2020, 116 patients were enrolled with a covariate adaptive randomization process based on: BMI, ASA score, baseline haemoglobin, UD, neoadiuvant chemo and cT-stage. Data from self-assessed questionnaires (EORTC-QLQ-C30 and QLQ-BLM30), peri- and postoperative data were collected. Unmodified HRQoL was defined as a 2yr Global Health status/QoL increase≥0 (ΔQL≥0) from baseline. Continence status was evaluated trough 3-day voiding diaries; day-time continence was defined as “totally dryness” (0gr), night-time continence as pad wetness ≤50gr. Univariable and multivariable logistic regression (LR) analysis were performed to identify predictors of 2yr ΔQL≥0. RESULTS: Out of 116 patients enrolled, 88 received ON, and 71 with a minimum 2yr follow-up were included. Two (2) patients were lost to follow-up and 17 patients died within 2yr after surgery. Baseline clinical features were reported (Tab.1). On multivariable LR analysis, day-time urinary continence and unmodified sexual functioning were independent predictors of 2yrs unmodified global health status (Tab. 2). Particularly, 54%, 30%, 72% and 65% of patients experienced unmodified 2 yrs global health status, sexual, social and emotional functioning, respectively; 62% of patients reported a totally dryness day-time urinary continence (Fig. 1). CONCLUSIONS: Recovery of completely dry day-time continence status and equal to baseline sexual functioning scores are main drivers of patients' HRQoL 2yrs after RC. These data highlight the need for further assessing oncological safety of sex-sparing techniques and technical improvements to maximize the likelihood of daytime continence recovery in patients receiving RC and ON. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e446 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Mastroianni More articles by this author Gabriele Tuderti More articles by this author Umberto Anceschi More articles by this author Alfredo Maria Bove More articles by this author Aldo Brassetti More articles by this author Simone D'annunzio More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Salvatore Guaglianone More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...

MP46-13 ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL PADUA ILEAL NEOBLADDER: LONG-TERM FUNCTIONAL OUTCOMES AND CONTINENCE PREDICTORS ASSESSMENT FROM A HIGH-VOLUME CENTER LARGE CONSECUTIVE SERIES

You have accessJournal of UrologyCME1 Apr 2023MP46-13 ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL PADUA ILEAL NEOBLADDER: LONG-TERM FUNCTIONAL OUTCOMES AND CONTINENCE PREDICTORS ASSESSMENT FROM A HIGH-VOLUME CENTER LARGE CONSECUTIVE SERIES Gabriele Tuderti, Riccardo Mastroianni, Umberto Anceschi, Alfredo Maria Bove, Aldo Brassetti, Mariaconsiglia Ferriero, Leonardo Misuraca, Salvatore Guaglianone, Michele Gallucci, and Giuseppe Simone Gabriele TudertiGabriele Tuderti More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Daytime urinary continence recovery following robot assisted radical cystectomy with intracorporeal orthotopic neobladder (RARC-iON) has been poorly investigated. In this study we reported long-term functional outcomes of RARC-iON and assessed the predictors of daytime urinary continence recovery. METHODS: Our single center IRB approved bladder cancer database was queried for “RARC” and “iON”.All patients treated between January 2012 and September 2020, with a minimum 1-yr follow-up were included. Baseline demographic, clinical, perioperative and pathologic data were reported. Functional outcomes included: renal function modification over time, neobladder stone formation, development of uretero-ileal anastomosis strictures, need for self-catheterization and Trifecta achievement (defined as the coexistence of daytime continence, Clavien-Dindo ≥3 complication-free and recurrence-free status, all assessed at 1 year).Day- and night-time continence recovery probabilities were assessed with Kaplan-Meier method; univariable and multivariable analyses were performed to identify predictors of day-time continence. RESULTS: Overall, 192 patients were included, 146 were male (76%).Mean baseline eGFR was 83.5 ml/min (± 23.5). At a median follow- up of 41 months (IQR 21-60), mean last eGFR was 63.8 ml/min (± 22.1).The incidence of significant renal function deterioration (newly onset CKD stage ≥3b) was 16.1%. Neobladder stones were reported in 16 patients (8.3%), all of which successfully treated as outpatient endoscopic procedure. Incidence of ureteroileal anastomosis stricture was 22.4%. Trifecta was achieved in 64.1% of cases. One-yr day- and night-time continence rates were 78.6 % and 48.3 %, respectively. At multivariable analysis age, female gender and severe 30-d complications occurrence were identified as independent predictors of lower day-time continence recovery probabilities. CONCLUSIONS: We reported functional outcomes of a large single center consecutive series of RARC-iON. Male, young and those patients who did not experience severe perioperative complications had significantly higher likelihood of recovering daytime urinary continence. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e636 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabriele Tuderti More articles by this author Riccardo Mastroianni More articles by this author Umberto Anceschi More articles by this author Alfredo Maria Bove More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Salvatore Guaglianone More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...

MP46-10 IMPACT OF LEARNING CURVE ON PERIOPERATIVE, ONCOLOGIC AND FUNCTIONAL OUTCOMES OF ROBOT ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL ORTHOTOPIC NEOBLADDER: SINGLE CENTER ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP46-10 IMPACT OF LEARNING CURVE ON PERIOPERATIVE, ONCOLOGIC AND FUNCTIONAL OUTCOMES OF ROBOT ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL ORTHOTOPIC NEOBLADDER: SINGLE CENTER ANALYSIS Gabriele Tuderti, Riccardo Mastroianni, Umberto Anceschi, Simone D'annunzio, Alfredo Maria Bove, Aldo Brassetti, Mariaconsiglia Ferriero, Leonardo Misuraca, Salvatore Guaglianone, Michele Gallucci, and Giuseppe Simone Gabriele TudertiGabriele Tuderti More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Simone D'annunzioSimone D'annunzio More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study was to assess the role of learning curve (LC) on perioperative, oncologic and functional outcomes of a single center series of Robotic Cystectomy and intracorporeal neobladder (RARC-ION) METHODS: The study population included all patients treated between January 2012 and September 2020. The entire cohort was divided in tertiles related to the time of surgery, to assess the effect of LC on the outcomes evaluated, including Trifecta achievement. Baseline, preoperative and perioperative data distribution across tertiles were assessed. Categorical and continuous variables among the three subgroups were compared with Chi square and ANOVA tests, respectively RESULTS: Overall, 192 patients were included. Operative time (p=0.05) and hospital stay (p=0.002) decreased significantly over time.Concerning perioperative complications, after an initial higher rate in the I tertile (low grade 39.7%,high grade 23.8%), since the II tertile decreased and remained stable over time, especially for Clavien ≥ 3 (II tertile 6.3%, III tertile 9.1%) (p=0.007).In terms of renal function impairment,we detected an improving trend in maintaining an eGFR > 45 ml/min during follow-up (new-onset of CKDstage≥3b 23.8%, 17.5% and 10.6% in I,II and III tertile).Trifecta achievement was significantly higher in II and III tertiles (I:49.2%; II:77.8%; III:65.2%, p=0.004).Although 2-yr CSS rate did not significantly differ between the groups, an improving trend across the tertiles (I: 63.5%, II: 75.9%; III: 76.2%, p=0.22) is observed.In terms of Day- time continence recovery at 12-mo follow-up, after a lower rate in the I tertile(75.9%), the day-time continence rate remained stable over 80% in patients belonging to the II (82.5%) and III (81.3%) tertile. CONCLUSIONS: Patients receiving RARC-iON are exposed to worse perioperative and functional results at the beginning of the learning curve. A strict selection of patients and the standardization of surgical steps may turn into rapid and stable improvement of key outcomes for this complex procedure. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e634 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabriele Tuderti More articles by this author Riccardo Mastroianni More articles by this author Umberto Anceschi More articles by this author Simone D'annunzio More articles by this author Alfredo Maria Bove More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Salvatore Guaglianone More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...

MP65-12 EVALUATION OF LONG-TERM FUNCTIONAL OUTCOMES OF ORTHOTOPIC NEOBLADDER IN THE ELDERLY USING A VALIDATED QUESTIONNAIRE

You have accessJournal of UrologyCME1 Apr 2023MP65-12 EVALUATION OF LONG-TERM FUNCTIONAL OUTCOMES OF ORTHOTOPIC NEOBLADDER IN THE ELDERLY USING A VALIDATED QUESTIONNAIRE Seyedeh Sanam Ladi Seyedian, Kasen Wong, Muhannad Alsyouf, Gus Miranda, Jie Cai, Kevin Wayne, Hooman Djaladat, Anne Schuckman, and Siamak Daneshmand Seyedeh Sanam Ladi SeyedianSeyedeh Sanam Ladi Seyedian More articles by this author , Kasen WongKasen Wong More articles by this author , Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Gus MirandaGus Miranda More articles by this author , Jie CaiJie Cai More articles by this author , Kevin WayneKevin Wayne 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/10.1097/JU.0000000000003323.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Elderly patients who require radical cystectomy (RC) are more likely to undergo an incontinent urinary diversion due to unclear long-term functional outcomes of a continent diversion. Herein, we evaluate the continence outcomes in elderly males undergoing orthotopic neobladder (ONB) diversion after RC using a validated questionnaire. METHODS: Using our IRB approved bladder cancer database, we identified male patients, 70 years old or older, who underwent open RC and ONB from 2002 to 2021. Beginning in 2012 the patients completed a validated pictorial pad use questionnaire at each follow-up visit. The questionnaire assessed pad number, size and wetness as well as catheter use. Continence was defined as use of “no pads” or pads that are “almost dry”. Urinary retention was defined as ≥3 catheterizations/day or a self-reported inability to void without a catheter. Patients with artificial urinary sphincters or less than 6 months of follow up were excluded from the study. Kaplan-Meier curves and cox regression were used to analyze the data. RESULTS: A total of 156 male patients with median age of 74 years (IQR: 72-77) and BMI of 26.7 (IQR: 24.2 - 29) were included. 64 (41%) patient were>75 years old. 42 (27%) patients received neoadjuvant chemotherapy. 71 (45.5%) patients had Charlson comorbidity index (CCI) score of>2. Fifteen (10%) patients had pathological staging >pT3 and 23 (15%) had pathological nodal disease. At 1 year following the surgery, half of the patients gained daytime continence and 30% gained nighttime continence which increased over the study period. Day and nighttime continence rates were 74% and 68% at 5 years postoperatively (figure 1). Only 13 (8%) patients developed retention over the study period. Patients>75 years old had worse nighttime continence outcome compared to <75 years old (p=0.07) (figure 1). Multivariate cox regression model including age, CCI, BMI, diabetes, and perioperative chemotherapy did not show any significant risk factor for daytime incontinence, however; age>75 was significantly associated with nighttime incontinence (HR 1.07, p=0.04). CONCLUSIONS: Orthotopic neobladder represents a viable option for urinary diversion in selected elderly males undergoing radical cystectomy and age alone should not be considered a contraindication. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e895 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seyedeh Sanam Ladi Seyedian More articles by this author Kasen Wong More articles by this author Muhannad Alsyouf More articles by this author Gus Miranda More articles by this author Jie Cai More articles by this author Kevin Wayne 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 PDF downloadLoading ...

V06-04 ROBOTIC-ASSISTED INTRACORPOREAL NEOBLADDER RECONSTRUCTION WITH Y-SHAPED RESERVOIR: VIDEO DESCRIPTION AND CLINICAL OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023V06-04 ROBOTIC-ASSISTED INTRACORPOREAL NEOBLADDER RECONSTRUCTION WITH Y-SHAPED RESERVOIR: VIDEO DESCRIPTION AND CLINICAL OUTCOMES Bernardo Rocco, Simone Assumma, Tommaso Calcagnile, Filippo Turri, Mattia Sangalli, Luca Sarchi, Giulia Garelli, Daniele Stroppa, Enrico Panio, Giorgio Bozzini, Salvatore Micali, Paolo Marcangeli, Angelica Grasso, Matteo Maggioni, Alberto Del Nero, Paolo Dell'Orto, and Maria Sighinolfi Bernardo RoccoBernardo Rocco More articles by this author , Simone AssummaSimone Assumma More articles by this author , Tommaso CalcagnileTommaso Calcagnile More articles by this author , Filippo TurriFilippo Turri More articles by this author , Mattia SangalliMattia Sangalli More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Giulia GarelliGiulia Garelli More articles by this author , Daniele StroppaDaniele Stroppa More articles by this author , Enrico PanioEnrico Panio More articles by this author , Giorgio BozziniGiorgio Bozzini More articles by this author , Salvatore MicaliSalvatore Micali More articles by this author , Paolo MarcangeliPaolo Marcangeli More articles by this author , Angelica GrassoAngelica Grasso More articles by this author , Matteo MaggioniMatteo Maggioni More articles by this author , Alberto Del NeroAlberto Del Nero More articles by this author , Paolo Dell'OrtoPaolo Dell'Orto More articles by this author , and Maria SighinolfiMaria Sighinolfi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One of the hardest surgical challenges for robotic surgeon is intracorporeal neobladder reconstruction during robotic radical cystectomy (RARC). In the present video, we illustrate a step-by-step description of the technique and the clinical outcomes from a single center series. METHODS: Overall, 40 RARC were performed between July 2021 and October 2022: 20/40 patients underwent intracorporeal neobladder reconstruction and were enrolled in the study. When RARC is completed, a 40-50 cm ileal segment is isolated and the part with adequate mesenteric length is approximated to the urethral stump. A modified posterior reconstruction is conducted. Anastomosis with a barbed suture is finalized. Ileal segments at each side are isolated using robotic staplers and ileal-ileal anastomosis is accomplished. Ileum's reverse tubular U-segment is detubularized to create the neobladder. Posterior plane is first sutured; then, the orhotopic reservoir with two lateral limbs is created. After negative leakage test, a direct uretero-neobladder anastomosis of each spatulated ureter is performed in the dorsal part of the limbs. Ureteral stents are placed and brought out through the abdominal wall. Anterior plate is finally sutured. RESULTS: Mean age was 64.5 years (48-75). Seventeen out of 20 patients were males; 3 were females. One non-surgical intra-operative complication (myocardial infarction requiring an acceleration of operative time) was recorded. During post-op course, two cases of urinary leakage at the neovescical-urethral anastomosis were evident and required prolonged catheterization. Mean length of stay was 17 days (12-27), excluding a single case of prolonged hospitalization due to C. Albicans superinfection. The 30-day readmission rate was 20% (4/20) due to febrile urinary tract infections; 90-day readmission rate was just 5% (1 symptomatic lymphocele requiring percutaneous drainage). Most male patients (14/17) reported daytime continence with insignificant post-voided residual. Between those patients in which nerve-sparing approach was pursued – and have more than 90 days of follow up – 3/5 referred potency. Regarding female patients, incomplete voiding is reported in a case and urinary incontinence (2 pads/day) in another. CONCLUSIONS: Intracorporeal neobladder reconstruction is a complex procedure even for expert robotic surgeons. Nevertheless, the standardization of the surgical approach – as displayed in the video – facilitates a rapid implementation of the procedure with positive surgical and clinical outcomes. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e509 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bernardo Rocco More articles by this author Simone Assumma More articles by this author Tommaso Calcagnile More articles by this author Filippo Turri More articles by this author Mattia Sangalli More articles by this author Luca Sarchi More articles by this author Giulia Garelli More articles by this author Daniele Stroppa More articles by this author Enrico Panio More articles by this author Giorgio Bozzini More articles by this author Salvatore Micali More articles by this author Paolo Marcangeli More articles by this author Angelica Grasso More articles by this author Matteo Maggioni More articles by this author Alberto Del Nero More articles by this author Paolo Dell'Orto More articles by this author Maria Sighinolfi More articles by this author Expand All Advertisement PDF downloadLoading ...

MP56-04 CONTEMPORARY ONCOLOGIC, FUNCTIONAL, AND COMPLICATIONS OUTCOMES OF ROBOT-ASSISTED RADICAL CYSTECTOMY WITH TOTALLY INTRACORPOREAL NEOBLADDER DIVERSION

MP56-04 CONTEMPORARY ONCOLOGIC, FUNCTIONAL, AND COMPLICATIONS OUTCOMES OF ROBOT-ASSISTED RADICAL CYSTECTOMY WITH TOTALLY INTRACORPOREAL NEOBLADDER DIVERSION

Open vs robotic intracorporeal Padua ileal bladder: functional outcomes of a single-centre RCT.

Functional outcomes of robot-assisted (RA) radical cystectomy (RC) with intracorporeal orthotopic neobladder (i-ON) have been poorly investigated. The study aimed to report functional outcomes of a prospective randomized controlled trial (RCT) comparing open RC (ORC) and RARC with i-ON. Inclusion criteria were cT2-4/N0/M0, or BCG-failure high-grade urothelial carcinoma, candidate to RC with curative intent. A covariate adaptive randomization process was used, based on the following variables: BMI, ASA score, haemoglobin levels, cT-stage, neoadjuvant chemotherapy, urinary diversion. Day-time continence was defined as "totally dryness", nigh-time continence as pad wetness ≤ 50cc. Continence recovery probabilities were compared between arms with Kaplan-Meier method and Cox regression analysis was performed to identify predictors of continence recovery. HRQoL outcomes analysis was assessed with a generalized linear mixed effect regression (GLMER) model. Out of 116 patients randomized, 88 received ON. Quantitative analysis of functional outcomes reported similar results in terms of day continence, while a better night continence status in ORC cohort was observed. However, 1-yrday- and night-time continence recovery probabilities were comparable. Night-time micturition frequency < 3h was the only predictor of nigh-time continence recovery. At GLMER, 1-yr body image and sexual functioning were significantly better in RARC cohort, while urinary symptoms were comparable between arms. Despite superiority of ORC at quantitative night-time pad use analysis, we showed comparable day- and night-time continence recovery probabilities. At 1-yr analysis of HRQoL outcomes, urinary symptoms were comparable between arms, while RARC patients reported lower body image and sexual functioning worsening.

Reproducibility of a modified posterior reconstruction during robotic intracorporeal neobladder reconfiguration.

Robotic intracorporeal neobladder reconstruction is a complex procedure in which the approximation of the reservoir to the urethral stump can be a demanding step. The aim of the study is to evaluate the reproducibility of a modified posterior reconstruction (PR) during the reconfiguration of intracorporeal neobladder after robot assisted radical cystectomy (RARC). From July 2021 to July 2022, 35 RARC were performed, and 17 patients underwent intracorporeal neobladder reconstruction. A PR was planned in males (14). Intra- and peri-operative data were collected. RARC and node dissection are performed. Afterwards, 40-cm ileal segment is isolated; the portion with the more adequate mesenteric length is brought down to the pelvis. A modified PR is performed with a double-armed barbed suture: a first layer connects the Denonvillier's fascia to the rhabdosphincter in a running fashion; the second layer is created with the other arm and approximates the posterior side of the ileal segment towards the urethral stump. In the anterior caudal part of the ileum, a 1.5-cm incision is made to realize the neobladder neck; the neovesical-urethral anastomosis is performed with a second bidirectional suture. Anastomotic and PR time were 14 (range 7-20) and 5 minutes (4-8), respectively. A single Clavien IIIa complication was recorded in a patient who underwent NAC and had a C. albicans superinfection in the post-operative course. All patients were discharged with complete or acceptable bladder voiding. Twelve patients with follow-up >90-days reported a satisfying daytime continence. PR represents a simple technical refinement that improves neobladder-urethral anastomosis by favoring ileal approximation to the urethral stump and decreasing anastomotic tension.

Relationship between primary monosymptomatic enuresis and process toilet training: a case-control.

Primary monosymptomatic nocturnal enuresis (PMNE) is a prevalent condition in childhood, and the pathophysiology is multifactorial. This study investigated the relationship between the toilet training process (TT) and PMNE in children and adolescents. A case-control study was carried out from 2015 to 2020. The presence of PMNE was identified according to International Children's Continence Society criteria. A semi-structured questionnaire was applied to assess TT. The study included 103 children and adolescents with PMNE and 269 participants with normal psychomotor development without PMNE (control group [CG]). Readiness signals were more remembered and less frequent in participants with PMNE (p=0.001) when compared to control group. No differences were found between the groups regarding the onset age of the daytime TT (p= 0.10), the nocturnal TT (p=0.08), the acquisition of daytime continence (p=0.06), and the type of equipment used for the TT (p=0.99). The use of Child-Oriented approach in group of children with enuresis was lower than in controls [87.4% (90/103) versus 94% (250/266)], respectively (OR= 0.44, 95% CI 0.21-0.94, p = 0.039). The age of onset of TT, acquisition of daytime continence, and the type of equipment were not associated with higher occurrence of PMNE. On the other hand, the Child-Oriented approach was a protective factor for the occurrence of PMNE.

Nerve-spring technique could achieve a functional trifecta outcome of robotic intracorporeal studer's orthotopic neobladder in the male.

To summarize some key steps of functional improvement in robotic intracorporeal studer's orthotopic neobladder (RISON) of males, especially for nerve-spring technique. We also presented the result of 1-year follow-up aimed to illustrate its functional trifecta outcomes. Robotic radical cystectomy with intracorporeal studer's orthotopic neobladder was performed on 33 male patients by the same surgeon from April 2018 to March 2019. Nerve-sparing technique had been used in 11 of the 33 patients. A prospectively maintained dataset was retrospectively searched and the related perioperative and follow-up data were analyzed. The functional trifecta outcomes referred to the freedom from recurrence, urinary continence and sexual function recovery after one year. A total of 33 males were included in our study. All perioperative information was recorded in detail. Thirty-two cases were confirmed to have negative surgical margin, except one pT3a case. And another case of incidental prostate cancer was diagnosed pathologically. All patients (100%) were recurrence-free one year after the operation. Eleven patients underwent nerve-sparing surgeries, including inter-fascial techniques or intra-fascial techniques. All these patients attained daytime continence (0 pad) at 1 month. With the nighttime continence, nerve-sparing group (2, 2,1) used fewer pads than other 22 cases (3, 3,2) at 1, 6 or 12 month(s) respectively. We defined urinary continence as 0 pad in daytime and no more than 1 pad in nighttime. The median preoperative score of International Index of Erectile Function (IIEF-6) in the 11 cases was 24. The sexual function recovery was defined as IIEF-6 > 20. The final trifecta rate was 54.5% and the median follow-up time lasted 17 months (range, 12 to 22 months). RISON could be a safe and feasible choice of urinary diversion. Nerve sparing techniques might help the patients achieve a relatively higher functional trifecta rate.