The aim of this study was to evaluate changes of bladder capacity and urinary function outcomes of patients undergoing ileal orthotopic neobladder reconstruction after being diagnosed with bladder cancer depending on the time using a bladder diary which is simple but very useful tool.

We retrospectively reviewed medical records of 136 patients who underwent ileal orthotopic neobladder reconstruction from January 2016 to December 2017 in our hospital. Out of these, only patients whose residual urine volume of 50 ml or less were selected as the subjects, and 3 cases who suffered from continuous incontinence caused by vaginal- neobladder fistula were excluded. Therefore, a total of 110 patients were selected for this study, and their bladder diaries, uroflowmetries, and Post-void residual urine volumes were examined. The time elapsed of the postoperative period was grouped at 3-month intervals to obtain the mean or percentage of the given variables. 24 hr urine volume, nocturnal urine volume, maximum voided volume, frequency and maximal flow rate were analyzed using Pearson’s correlation to see if there was any change with time after surgery. And changes in the incidence of incontinence were analyzed by t-test.

There was no statistically significant correlation between the changes of 24hr urine volume, nocturnal urine volume, maximum voided volume and maximal flow rate any change with time after surgery. However, 24hr frequency (r=-.21, p=.001) including daytime frequency (r=-.19, p=.002) and nocturia (r=.13, p=.047) showed a significant negative correlation and decreased with time after surgery.
Daytime incontinence and nighttime incontinence refer to a record in the bladder diary of a patient who had suffered from urinary incontinence at least one, and both have a limitation in that they could not be measured the severity. However, both daytime (t=2.86, p=.005) and nighttime (t=2.99, p=.003) incontinences significantly decreased with time. The incidence of daytime incontinence was 30.8% and the incidence of nighttime incontinence was 69.2% between 10 and 12 months after surgery. This showed that nighttime incontinence still had high incidence until that time.

The results showed that only urinary frequency and incontinence significantly changed while the maximum voided volume, which was fixed within 3 months after surgery, did not significantly change thereafter. It was found that the bladder volume, which was just approximately 200 ml at the initial stage of surgery, reached 400 to 500 ml similar to the normal bladder volume within 3 months.

Bladder diary is a very useful tool to evaluate functional outcomes after ileal orthotopic neobladder reconstruction without invasion or complexity. Patients who underwent neobladder through a bladder diary can have a very effective approach to correctly acquiring new voiding methods.1)

Ong K et al. Orthotopic Bladder Substitution (Neobladder) Part I: Indications, Patient Selection, Preoperative Education and Counseling. J Wound Ostomy Continence Nurs. 2013;40(1):73-82.