title: Superior functional outcome after radical cystectomy and orthotopic bladder substitution with restrictive intraoperative fluid management: a followup study of a randomized clinical trial.
abstract: OBJECTIVE
  Continuous intraoperative norepinephrine infusion combined with restrictive deferred hydration improves surgical field visibility, and significantly decreases intraoperative blood loss and postoperative complications in patients undergoing radical cystectomy and urinary diversion. We determined whether the intraoperative fluid regimen would affect functional results (continence and erectile function) 1 year after orthotopic ileal bladder substitution.
  
  
  METHODS
  We analyzed a subgroup of 93 patients who received an ileal orthotopic bladder substitute. The subgroup was part of a randomized trial in 167 patients initially allocated to continuous norepinephrine administration starting with 2 μg/kg per hour combined with 1 ml/kg per hour initially and 3 ml/kg per hour crystalloid infusion after cystectomy (norepinephrine/low volume group of 51) or a standard crystalloid infusion of 6 ml/kg per hour throughout surgery (42 controls). We prospectively assessed daytime and nighttime continence, and erectile function 1 year postoperatively in the 93-patient subgroup.
  
  
  RESULTS
  Daytime continence was reported by 44 of 51 patients (86%) in the norepinephrine/low volume group and by 27 of 42 controls (64%) (p = 0.016), and nighttime continence was reported by 38 (75%) and 25 (60%), respectively (p = 0.077). Erectile function recovery was reported by 26 of 33 preoperatively potent patients (79%) in the norepinephrine/low volume group and by 11 of 29 controls (38%) (p = 0.002).
  
  
  CONCLUSIONS
  Patients who undergo radical cystectomy and orthotopic bladder substitution with continuous norepinephrine infusion and restrictive hydration during surgery have significantly better daytime continence and erectile function 1 year postoperatively.
authors.affiliation: Department of Urology, University Hospital Bern, Bern, Switzerland. Electronic address: fiona.burkhard@insel.ch.
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Burkhard
authors.affiliation: Department of Urology, University Hospital Bern, Bern, Switzerland.
authors.forename: Urs E
authors.initials: UE
authors.lastname: Studer
authors.affiliation: Department of Anesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland.
authors.forename: Patrick Y
authors.initials: PY
authors.lastname: Wuethrich
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods; D004311:Double-Blind Method; D007172:Erectile Dysfunction / Q000517:prevention & control; D005260:Female; D005440:Fluid Therapy; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control; D016896:Treatment Outcome; D014547:Urinary Diversion; D014549:Urinary Incontinence / Q000517:prevention & control
chemical_list: D009638:Norepinephrine
keywords: cystectomy; erectile dysfunction; norepinephrine; urinary bladder; urinary incontinence