title: Prospective Evaluation of Continence Following Radical Cystectomy and Orthotopic Urinary Diversion Using a Validated Questionnaire.
abstract: We evaluated continence outcomes in male patients undergoing orthotopic neobladder diversion after radical cystectomy using a validated questionnaire.
  
  
  
  Using our institutional review board approved bladder cancer database we identified 1,269 patients who underwent open radical cystectomy from 2002 to 2015. Orthotopic neobladder was constructed in 935 (74%) patients, of whom 798 (85%) were male. Beginning in 2012 the patients completed a validated pictorial pad use questionnaire at each followup visit. The questionnaire assessed pad number, size and wetness as well as catheter use. Continence was defined as use of no pads or pads that are almost dry. Questionnaires were stratified into distinct postoperative intervals for analysis. Female patients, or patients with artificial urinary sphincters or prior radiotherapy were excluded from the study.
  
  
  
  A total of 188 male patients with available questionnaires were followed from September 2012 to August 2015. Overall 447 questionnaires were collected, with 351 interval distinct questionnaires separated into intervals of less than 3, 3 to 6, more than 6 to 12, more than 12 to 18, more than 18 to 36 and more than 36 months after surgery (64, 61, 58, 49, 61 and 58 questionnaires, respectively). Daytime continence increased from 59% at less than 3 months postoperatively to 92% by more than 12 to 18 months. Nighttime continence increased from 28% at less than 3 months postoperatively to 51% by more than 18 to 36 months. Nearly 50% of patients reported daytime and nighttime continence by 18 to 36 months.
  
  
  
  After orthotopic neobladder diversion in male patients, continence improves significantly by 6 months and subsequently plateaus with 92% daytime continence by more than 12 to 18 months. Orthotopic neobladder represents an excellent functional option for urinary diversion.
authors.affiliation: USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Clifford
authors.affiliation: USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
authors.forename: Swar H
authors.initials: SH
authors.lastname: Shah
authors.affiliation: USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
authors.forename: Soroush T
authors.initials: ST
authors.lastname: Bazargani
authors.affiliation: USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
authors.forename: Gus
authors.initials: G
authors.lastname: Miranda
authors.affiliation: USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
authors.forename: Jie
authors.initials: J
authors.lastname: Cai
authors.affiliation: USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
authors.forename: Kevin
authors.initials: K
authors.lastname: Wayne
authors.affiliation: USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
authors.forename: Hooman
authors.initials: H
authors.lastname: Djaladat
authors.affiliation: USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Schuckman
authors.affiliation: USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California. Electronic address: daneshma@med.usc.edu.
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
mesh_terms: D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000009:adverse effects*; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D001743:Urinary Bladder / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects*; D014549:Urinary Incontinence / Q000209:etiology*; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects*
keywords: cystectomy; urinary diversion; urinary incontinence