Long-term functional outcomes after radical cystectomy with ileal bladder substitute: does the definition of continence matter?

Functional outcomes after ileal bladder substitution reflect the expectations of future patients at a particular centre. The aim of this study was to use validated questionnaires and a pad-weighing test to investigate functional outcomes after neobladder reconstruction at long-term follow-up in pati...

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Bibliographic Details
Published in:	Scandinavian journal of urology Vol. 51; no. 1; p. 44
Main Authors:	Liedberg, Fredrik, Ahlgren, Göran, Baseckas, Gediminas, Gudjonsson, Sigurdur, Håkansson, Ulf, Lindquist, Sara, Löfgren, Annica, Patschan, Oliver, Siller, Carina, Sjödahl, Gottfrid
Format:	Journal Article
Language:	English
Published:	England 02-01-2017
Subjects:	Aged Carcinoma, Transitional Cell - surgery Cystectomy - methods Erectile Dysfunction - epidemiology Female Follow-Up Studies Humans Ileum - transplantation Incontinence Pads Male Middle Aged Postoperative Complications - epidemiology Postoperative Complications - etiology Self Report Sexual Dysfunction, Physiological - epidemiology Surveys and Questionnaires Treatment Outcome Urinary Bladder Neoplasms - surgery Urinary Diversion - methods Urinary Incontinence - epidemiology Urinary Incontinence - etiology Urinary Reservoirs, Continent Continence potency ICIQ-UI-SF IIEF functional outcome neobladder radical cystectomy
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Summary:	Functional outcomes after ileal bladder substitution reflect the expectations of future patients at a particular centre. The aim of this study was to use validated questionnaires and a pad-weighing test to investigate functional outcomes after neobladder reconstruction at long-term follow-up in patients at a single centre. During 2005 - 2015, 75 patients received a Studer ileal bladder substitute at the Department of Urology, Malmö. Forty-six of these patients were alive for follow-up and were evaluated using the pad-weighing test and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). Five of 37 evaluable patients (14%) were considered fully continent, reporting a pad-weighing test result of 0 g and an ICIQ-UI-SF score of 0. The median ICIQ-UI-SF score was 8 [interquartile range (IQR) 3-11], and seven patients (17%) were continent according to the ICIQ-UI-SF score only. In the pad-weighing test, 28 out of 37 patients (76%) reported 0 g day-time leakage whereas only 12 out of 37 patients (32%) reported 0 g night-time leakage. At follow-up, nine out of 39 (23%) of evaluable male patients were potent. The median ICIQ-UI-SF score was significantly lower during the second half of the study period [4 (IQR 0-8) vs 10 (IQR 6-14); p = .003]. The inverse applied to the median IIEF score [5 (IQR 3-12) vs 2 (IQR 1-4); p = .02]. Functional outcomes at long-term follow-up after radical cystectomy and Studer ileal bladder substitute were at best modest in this series. Better outcomes during the second half of the study period might be explained by improved patient selection and a refined surgical technique, but possibly also by longer follow-up of patients during the first half of the period resulting in a more pronounced time-dependent decline in functional outcomes.
ISSN:	2168-1813
DOI:	10.1080/21681805.2016.1249943