title: Can we predict the need for clean intermittent catheterization after orthotopic neobladder construction?
abstract: BACKGROUND
  We aimed to identify peri-operative and pathologic characteristics that may predict the need for clean intermittent catheterization (CIC) following radical cystectomy (RC) with orthotopic neobladder (ONB) in order to improve patient counseling on choice of urinary diversion.
  
  
  METHODS
  Between July 2004 and February 2013, all patients who underwent RC with ONB were identified. Peri-operative clinical and pathological features were evaluated and correlated with patients reported need for CIC. The independent T-test was performed for continuous variables and Chi-square test was performed for categorical variables. Multivariate forward stepwise logistic regression analysis was used to identify variables that correlated with need for CIC after ONB.
  
  
  RESULTS
  During the study period, 114 patients underwent RC with ONB creation. On univariate analysis, patients with higher body mass index, younger age, and non-vaginal or non-nerve-sparing procedures were more likely to require catheterization for complete emptying. Multivariate analysis demonstrates that conservative surgery (nerve sparing in males or vaginal sparing in females) was associated with a significantly lower rate of requiring CIC (Odds Ratio [OR] 0.20, P < 0.01). Surprisingly, older age was also associated with a slightly lower, but statistically significant, rate of requiring CIC (OR 0.92,P < 0.01).
  
  
  CONCLUSIONS
  When counseling patients regarding the different types of diversions after RC, the potential need for long-term CIC after ONB must be discussed. The clinical factors that appear to increase the need for CIC include non-conservative RC (non-nerve sparing in males and non-vaginal sparing in females) and, to a certain degree, younger age.
authors.affiliation: Department of Urology, University of Kansas Medical Center, MO, Kansas City, KS, USA.
authors.forename: Katie S
authors.initials: KS
authors.lastname: Murray
authors.affiliation: Department of Urology, University of Kansas Medical Center, MO, Kansas City, KS, USA.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Arther
authors.affiliation: Department of Urology, University of Kansas Medical School, MO, Kansas City, KS, USA.
authors.forename: Keegan P
authors.initials: KP
authors.lastname: Zuk
authors.affiliation: Department of Urology, University of Kansas Medical Center, MO, Kansas City, KS, USA.
authors.forename: Eugene K
authors.initials: EK
authors.lastname: Lee
authors.affiliation: Department of Urology, Kansas City Veterans Administration, MO, Kansas City, KS, USA.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Lopez-Corona
authors.affiliation: Department of Urology, University of Kansas Medical Center, MO, Kansas City, KS, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Holzbeierlein
keywords: Catheterization; cystectomy; neobladder