Nighttime Continence Research Articles

Outcomes after robot-assisted radical cystectomy with orthotopic neobladder in women

PurposeTo investigate functional, oncological and complication outcomes in women undergoing robot-assisted cystectomy (RARC) with intracorporeal orthotopic neobladder.MethodsFrom a multi-institutional database, we identified females with bladder cancer treated with RARC and intracorporeal orthotopic neobladder. We evaluated the continence rate, short-term oncological outcomes, and complication rates. Analyses were repeated and stratified by the status of preserving gynecological organs.ResultsThe study involved 146 patients with the median age 60 years (IQR, 51–66 years). Pelvic organ-preserving procedure (POP) was performed in 77 patients (53%). Overall daytime and nighttime continence rates were 54% and 53%, respectively. For POP, the continence rate was 58% for both daytime and nighttime continence. In the non-POP cohort, the continence rate was 50% for daytime and 49% for nighttime continence. Both groups had balanced positive surgical margin rates (5,3% for POP and 4,7% for non-POP). In the whole cohort, high-grade (Clavien-Dindo ≥3) early and late complication rate was 7,5% and 7,5%, respectively.ConclusionsRobot-assisted radical cystectomy with intracorporeal orthotopic neobladder in females demonstrate excellent functional and complication outcomes. Pelvic organ-preserving cystectomy enhances urinary continence rates without adversely affecting surgical margins. Orthotopic neobladder in selected women with bladder cancer, along with pelvic organ-preserving cystectomy may be used for improved functional outcomes without compromising oncological results.

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.

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.

New concept in urologic surgery: The total extended genital sparing radical cystectomy in women

The aim of the study was to evaluate genital sparing radical cystectomy surgery in female patients from the point of view of both oncologic and functional outcomes (with emphasis on urinary and sexual outcomes) in a single high-volume center for the treatment of muscular invasive bladder cancer. Between January 2014 and January 2018, 14 female patients underwent radical cystectomy with preservation of genital organs (the entire vagina, uterus, fallopian tubes, ovaries) and orthotopic urinary neobladder (Padua neobladder). Inclusion criteria were recurrent T1G3 tumors; refractory tumors after BCG therapy without associated carcinoma in situ (CIS); T2 or T3a tumors entirely resected at endoscopic transurethral resection of the bladder and not involving urethra/bladder trigone. Exclusion criteria were: T3b or higher bladder cancer, associated CIS and involvement of urethra or bladder trigone. Oncological and histopathological outcomes (Overall Survival - OS, Recurrence Free Survival - RFS), urinary outcomes (day and night incontinence, intermittent catheterization use, Sandvik Score) and sexual outcomes (Female Sexual Function Index 19 FSFI-19) were considered. The average follow-up time was 56 months. Considering oncological outcomes, histologic examination reported urothelial carcinoma in 13/14 patients; 8/13 patients (61.5%) had high grade T1 stage, 3/13 patients (23%) had high grade T2 stage and finally 2/13 patients (15.5%) had high-grade T3 stage. One patient presented with embryonal rhabdomyosarcoma completely excised after surgery (PT2aN0M0). No patient developed local or metastatic recurrence (RFS 100%); OS was 100%. Considering urinary continence outcomes, 12/14 patients retained daytime and nighttime continence (85.5%); 2/14 (14.5%) complained of low stress urinary incontinence daily and nighttime urinary leakage. The Sandvik Score showed complete continence in 7/14 patients (50%); mild degree incontinence in 6/14 patients without use of incontinence devices (43%); moderate degree of incontinence in one patient (7%). The FSFI administered at 1 year from the surgery showed sexual desire in all patients (100%); subjective arousal, achievement of orgasm and sexual satisfaction in 12/14 patients (85.5%); sufficient lubrication in 11/14 patients (78.5%). Only one patient (7%) complained about dyspareunia during sexual intercourse. Our study aims to demonstrate that genital-sparing radical cystectomy is a safe surgery in terms of oncologic outcomes and, most importantly, that it is beneficial in terms of urinary and sexual function. Indeed, patients' quality of life together with their psychological and emotional health should be put on the same level as oncological safety. However, it is a treatment reserved for selected patients who are strongly motivated to preserve fertility and sexual function and thoroughly informed about the benefits and complications of such a procedure.

Robot-assisted Radical Cystectomy with Orthotopic Neobladder Reconstruction: Techniques and Functional Outcomes in Males

BackgroundLittle is known regarding functional outcomes after robot-assisted radical cystectomy (RARC) and intracorporeal neobladder (ICNB) reconstruction. ObjectiveTo report on urinary continence (UC) and erectile function (EF) at 12 mo after RARC and ICNB reconstruction and investigate predictors of these outcomes. Design, setting, and participantsWe used data from a multi-institutional database of patients who underwent RARC and ICNB reconstruction for bladder cancer. Surgical procedureThe cystoprostatectomy sensu stricto followed the conventional steps. ICNB reconstruction was performed at the physician’s discretion according to the Studer/Wiklund, S pouch, Gaston, vescica ileale Padovana, or Hautmann technique. The techniques are detailed in the video accompanying the article. MeasurementsThe outcomes measured were UC and EF at 12 mo. Results and limitationsA total of 732 male patients were identified with a median age at diagnosis of 64 yr (interquartile range 58–70). The ICNB reconstruction technique was Studer/Wiklund in 74%, S pouch in 1.5%, Gaston in 19%, vescica ileale Padovana in 1.5%, and Hautmann in 4% of cases. The 12-mo UC rate was 86% for daytime and 66% for nighttime continence, including patients who reported the use of a safety pad (20% and 32%, respectively). The 12-mo EF rate was 55%, including men who reported potency with the aid of phosphodiesterase type 5 inhibitors (24%). After adjusting for potential confounders, neobladder type was not associated with UC. Unilateral nerve-sparing (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.88–7.85; p < 0.001) and bilateral nerve-sparing (OR 6.25, 95% CI 3.55–11.0; p < 0.001), were positively associated with EF, whereas age (OR 0.93, 95% CI 0.91–0.95; p < 0.001) and an American Society of Anesthesiologists score of 3 (OR 0.46, 95% CI 0.25–0.89; p < 0.02) were inversely associated with EF. ConclusionsRARC and ICNB reconstruction are generally associated with good functional outcomes in terms of UC. EF is highly affected by the degree of nerve preservation, age, and comorbidities. Patient summaryWe investigated functional outcomes after robot-assisted removal of the bladder in terms of urinary continence and erectile function. We found that, in general, patients have relatively good functional outcomes at 12 months after surgery.

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.

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 ...

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 ...

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.

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.

Oncological and functional outcomes of organ-preserving cystectomy versus standard radical cystectomy: A systematic review and meta-analysis.

Radical cystectomy (RC) is historically considered the gold standard treatment for muscle invasive and high-risk non-muscle invasive bladder cancer. However, this technique leaves the majority of patients of both sexes with poor sexual and urinary function. Organ-sparing cystectomy (OSC) techniques are emerging as an alternative to the standard procedure to preserve these functions, without compromising the oncological outcomes. We present a systematic review and meta-analysis of the published literature. MEDLINE, Embase and Web of Science were systematically searched for eligible studies on 6 April 2021. Primary outcomes studied were both oncological outcomes, specifically overall recurrence, and functional outcomes, specifically sexual function, and daytime and nighttime continence. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated. The PROSPERO registration reference number was CRD42018118897. From 13 894 identified abstracts, 19 studies (1886 male and 305 female patients) were eligible for inclusion in this review. These studies included patients who underwent either whole prostate, prostate capsule, seminal vesicle, nerve, uterus, ovary, vagina and fallopian tube sparing techniques. Four studies included only female patients.Thirteen studies reported oncological outcomes, and overall recurrence rate was similar between the two groups (five studies; OR 0.73; 95% CI 0.38-1.40, p= 0.34). Thirteen studies reported on male sexual function. In men, OSC had significantly greater odds of retaining potency (five studies; OR 9.05; 95% CI 5.07-16.16, p< 0.00001). Fourteen studies (13 on males and 1 female) reported urinary outcomes. In men, OSC demonstrated greater odds of daytime (seven studies; OR 2.61; 95% CI 1.74 to 3.92, p< 0.00001) and nighttime continence (seven studies; OR 2.62; 95% CI 1.76 to 3.89, p< 0.00001). In carefully selected patients, OSC allows the potential to provide better sexual and urinary function without compromising oncological outcomes. There remains, however, a paucity of OSC studies in females. Further studies are required to make recommendations based on robust clinical evidence.

Сравнительный анализ робот-ассистированной и открытой радикальной цистэктомии с ортотопической деривацией мочи

Robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder creation is a complex surgical procedure, which is gradually becoming an alternative to open surgery.To compare the perioperative, functional and oncological outcomes of open radical cystectomy (ORC) and RARC.RARC with ileocystoplasty was performed in 25 patients, including 24 men. The average age was 65.5 years. ORC was done in 30 patients (28 men; control group) with the mean age of 67.2 years. In RARC, the ureters were isolated at the level of lower thirds, the bladder was dissected from the rectum on both sides, then the bladder vessels were divided using clips, and the urethra was cut off. After pelvic lymph node dissection, 50 cm of the ileum was resected. Then two distal segments were folded in a U-shape, a 1.5 cm incision was made in the lower part, and an anastomosis with the urethra was carried out. Further, these segments were detubularized and a modified Studer reservoir was created. The ureters were implanted into the tubular part. In ORC, urine diversion was also done using Studer technique. In both groups, the operation time, the volume of blood loss, the number of complications, the duration of hospitalization, the proportion of daytime and nighttime continence were evaluated.The mean time for RARC and ORC was 380 (320-580) and 260 (220-320) min, respectively (p<0.05). In the group of RARC, the volume of blood loss was 85 (50-250) ml and no blood transfusion was performed, while in ORC, the volume of blood loss was 520 (350-1400) ml, an average of 480 (0-840) ml of blood was transfused (p<0.05). After RARC, 30- and 90- complications rate was 32.0% (n=8) and 24.0% (n=6), respectively, compared to 40.0% (n=12) and 30.0% (n=9) in ORC. One patient died due to myocardial infarction during the 90-day follow-up period after RARC (grade V complication according to Clavien). The average number of removed lymph nodes in the RARC group was 15 (10-18). One patient had lymph node metastases. There were no cases of local recurrence. In ORC, the average number of lymph nodes was 16 (11-20), metastases were detected in 2 patients. One of them was subsequently diagnosed with local recurrence. There was no significant difference in the number of lymph nodes removed between two groups. After RARC, 20 (80.0%) patients had complete urinary continence, while 5 patients (20.0%) used 1-2 pads per day. Night continence was preserved in 15 cases (60.0%). After ORC, complete urinary continence was seen in 23 cases (76.7%). Five patients (20.0%) used 1-2 pads per day and two patients (6.7%) used 2-3 pads per day. Night continence after ORC was preserved in 17 cases (56.7%).RARC is a minimally invasive method of surgical treatment of patients with muscle-invasive bladder cancer. Compared with ORC, a significantly lower rate of complications and blood transfusions is documented, but RARC requires a longer operation time. Both interventions provide the equivalent oncological and functional outcomes, which are in line with published data.

Urodynamic assessment and quality of life outcomes of robot-assisted totally intracorporeal radical cystectomy and orthotopic neobladder for bladder cancer: a preliminary study.

Few data exist regarding the functional outcomes of robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder. The aim of this study was to evaluate the urodynamic and functional outcomes in patients undergoing RARC and totally intracorporeal orthotopic neobladder for bladder cancer. In this monocentric, observational study carried out between 2016 and 2020, consecutive patients undergoing RARC and intracorporeal orthotopic neobladder in the Department of Urology, Pitié-Salpêtrière Hospital, were included. Reconstruction was totally intracorporeal Y-shaped neobladder. Main outcomes were urodynamic findings 6months post-surgery, continence and quality of life (QoL). Continence was defined by no pad or one safety pad. International Consultation on Incontinence Questionnaire (ICIQ), International Index of Erectile Function questionnaire (IIEF-5) and Bladder Cancer Index (BCI) scores were recorded. Fourteen male patients were included (median age: 64years [IQR 54-67]. Median maximal neobladder cystometric capacity was 495ml [IQR 410-606] and median compliance was 35.5ml/cm H2O [IQR 28-62]. All patients had post-void residual volume < 30ml, except for three (22%) who required clean intermittent-self catheterisation. Daytime continence was achieved in 10 patients (71%) and night-time continence in two (14.3%). Median ICIQ score was 7 [IQR 5-11]. Postoperative erectile function was present in 7% of patients (mean IIEF-5 = 5 [IQR 2-7]). Thirteen patients (93%) were satisfied with their choice of neobladder. RARC with totally intracorporeal orthotopic neobladder for bladder cancer provides satisfactory urodynamic results and good QoL. These findings should be confirmed long-term.

Urethral duplication as cause of incontinence in a 5-years-old female: Surgical approach

Duplication of the urethra is a rare congenital anomaly in females which, if left unidentified, might cause refractory urinary incontinence. This video demonstrates its identification and treatment. A 5-year-old female was referred for primary refractory diurnal incontinence without any dry moment since birth. Initial clinical examination showed permanent urine leakage from an opening cranial to the clitoris. Ultrasound did not show any bladder or kidney abnormalities. A diagnostic cystoscopy under anesthesia revealed an accessory meatus located cranially to the orthotopic meatus and to the clitoris. Lying in dorsal decubitus under general anesthesia, catheters were inserted in respectively the orthotopic and accessory meatus. The accessory meatus and urethra were dissected away into the bladder dome from a circumferential skin incision. Defects were closed and bladder drainage per urethram was left in situ for 10 days. P ostoperative recovery was uncomplicated. Complete resolution of the incontinence was immediately achieved at catheter removal. Daytime and night-time continence are observed with 3 years follow-up. Urethral duplication is a rare finding in females but should be excluded during the workup of primary incontinence. In girls with isolated urethral duplication, resection of the accessory urethra is the best surgical option.