Hypothesis / aims of study
Radical cystoprostatectomy in men and radical cystectomy with anexohysterectomy in women with pelvic lymphadenectomy are the surgeries of choice for treatments with curative intent in patients with recurrent non-muscle-invasive (T1) or muscle invasive bladder tumors (T2). Once the bladder is excised, the urine must be derived. There are multiple forms of urinary diversion, such as cutaneous uretherostomy and continent and noncontinent reservoirs, which may be orthotopic or heterotopic in turn. The orthotopic ileal neoreservoir, in the present, is the reconstruction of the urinary tract that most resembles the physiological, seeking urinary continence and voluntary urination through the patient's native urethra. It also presents less negative impact on perception of body image for patients. The segment mostly used of the intestinal tract in adults is the small intestine, obtaining reservoirs of good capacity, even occasionally needing intermittent catheterization to be able to empty it completely. The incontinence rate is not negligible, which can alter the quality of life of patients. The aim of this study is to analyze the incidence and risk factors for urinary incontinence after orthotopic ileal neoreservorium for bladder cancer.
Study design, materials and methods
A retrospective cohort study was carried out in a single institution. The information was taken from the electronic medical record. All patients gave their consent for the anonymous use of their data.
Definitions: The degree of incontinence was measured based on the daily pad count: mild (1 pad), moderate (2 - 4 pads) and severe (5 or more pads). Success in continence was defined as those patients who were dry or requiring 1 pad.
Surgical technique: All patients underwent radical cystectomy and pelvic lymphadenectomy. In male patients, the prostate was also removed and in female patients the uterus and the ovaries were removed. The urinary reconstruction was performed with 50 cm of distal ileum according to the Padovana or Studer technique.
Statistical analysis: Continuous variables were described as mean and standard deviation or as median and range according to the observed distribution. The categorical variables were presented as absolute and relative frequencies (percentages). A univariate logistic regression analysis was performed with odds ratio calculation. The significant variables in the univariate were analyzed in the multivariate. A p <0.05 is considered significant.
Interpretation of results
Male sex and younger age were significantly associated with better continence results (OR 3.19 and 0.91 respectively).
In this study we analyze the continence and incontinence rate in patients with orthotopic ileal neoreservorium. We found that almost 50% of patients were dry during follow-up. Of the patients with stress urinary incontinence, the majority (33%) presented nocturnal enuresis with a requirement of 1 pad per night. 17% of patients had a more significant urinary incontinence with the need to use 2 or more pads per day. Although it could not be demonstrated in a statistically significant way, we found a tendency to better results in continence in men. On the other hand, we found that a younger age was related to better continence results in both men and women.