MP25-04: Impact of self-clean intermittent catheterization in orthotopic ilael neobladder: functional outcomes, continence status and urinary tract infections
Saturday, May 14, 2022
10:30 AM – 11:45 AM
Location: Room 228
Antonio Luigi Pastore*, Andrea Fuschi, Yazan Al Salhi, Alessia Martoccia, Lorenzo Capone, Silvio Scalzo, Paolo Pietro Suraci, Onofrio Antonio Rera, Fabio Maria Valenzi, Alice Antonioni, Antonio Carbone, Latina , Italy
Introduction: Orthotopic ileal neobladder (OIN) is the preferred urinary diversion after radical cystectomy (RC) with the main advantage of body image preservation, although its quality of life improvements are still under discussion. The principal factors associated with decrease in quality of life are continence status (both incontinence as well as urinary retention) and urinary tract infections (UTIs). The aim of this study is to investigate whether a clean intermittent catheterization within one month from OIN reconstruction could improve functional outcomes, continence status, and might be associated with a reduction of UTIs.
Methods: All patients were studied postoperatively at 1, 3, 6, and 9 months after OIN. Inclusion criteria were the ability to perform self catheterization, and to empty the neobladder using abdominal straining. The CIC was executed 4 times/daily after each voluntary micturition. Exclusion criteria were diabetes mellitus, neurological conditions, cognitive impairment, and urethral strictures. The postoperative evaluation included: post-void residual volume (PVR), urine analysis and culture, number of pads/day, and the self administrated questionnaire International Consultation On Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF).
Results: From September 2017 to March 2020, 15 male patients, and 8 female patients underwent laparoscopic or robot assisted RC with OIN (16 Padua and 7 Studer reconstructions).All patients completed the six months follow- up(mean 8.2 months;range 6-19 months). At the first follow up all patients were able to do self CIC. At this time mean PVR was 176.5 mL, ICIQ-UI SF mean score was 16, mean no. of pads/day was 3, 14 patients reported 3 episodes of symptomatic UTIs (Escherichia coli was the most common pathogen). At 3 and 6 months follow up after surgery the PVR was significantly reduced with a mean of 111.4 and 60.5 mL, respectively. The ICIQ-UI SF scores at 3 and 6 months were 12 and 9, respectively. The number of pads remained unchanged at 3 months whereas at 6 months decreased to 2 pads/day. The episodes of UTIs significantly decreased over the time with only 6 patients at 3 months (reporting 4 symptomatic episodes) and 3 patients at 6 months (reporting a single episode of febrile UTI).
Conclusions: This study confirmed that PVR is one of the most important parameter related with episodes of symptomatic UTIs, pads use and continence status. The data reported supports the early introduction of self CICs in patients with OIN after RC. Self CIC in these patients was significantly associated with quality of life improvement related to the continence status and the reduction of UTIs episodes.