title: Prognostic Features for Objectively Defined Urinary Continence after Radical Cystectomy and Ileal Orthotopic Neobladder in a Contemporary Cohort.
abstract: We objectively quantified daytime and nocturnal continence rates, and defined predictive features for favorable continence outcomes after radical cystectomy and orthotopic ileal neobladder creation.
  
  
  
  At 1 institution 1,012 cystectomies were performed between 2004 and 2015. Questionnaires evaluating the continence status were sent to 244 patients. To objectify postoperative urine loss daytime and nocturnal pad tests were performed. Continence was defined as the need for up to 1 safety pad and urine loss 10 gm or less per test. Predefined associative features were tested for an influence on continence outcomes. Statistical analysis was done with the Fisher exact and Mann-Whitney U tests, and linear logistic regression models. Significance was considered at p <0.05.
  
  
  
  A total of 188 patients (77.0%) returned the questionnaires. Median followup was 61 months. Median daytime pad use was 1 pad per day (range 0 to 9). Median daily urine loss based on standardized pad testing was 8 gm (range 0 to 2,400). During the night a median of 1 pad (range 0 to 7) was used and median nocturnal urine loss was 28.5 gm (range 0 to 1,220). The continence rate was 54.3% during the day and 36.3% at night. On multivariate analysis good preoperative ECOG (Eastern Cooperative Oncology Group) status (OR 2.987, p = 0.010), retained sensation of bladder filling (OR 6.462, p = 0.003) and preoperative coronary heart disease (OR 0.036, p = 0.002) were independent predictors of daytime success. Based on preoperative risk factors a simple predictive score for daytime continence was created (AUC 0.725, p <0.001).
  
  
  
  Continence rates after orthotopic ileal neobladder creation are lower than previously described when objective continence definitions are applied. Patients with good performance status, without coronary heart disease and with retained sensation of orthotopic ileal neobladder filling have better daytime continence outcomes.
authors: Department of Urology, Ludwig-Maximilians-University Munich, Germany; Department of Urological Sciences, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: alexander.kretschmer@med.uni-muenchen.de.
authors: Alexander
authors: A
authors: Kretschmer
authors: Department of Urology, Ludwig-Maximilians-University Munich, Germany.
authors: Tobias
authors: T
authors: Grimm
authors: Department of Urology, Ludwig-Maximilians-University Munich, Germany.
authors: Alexander
authors: A
authors: Buchner
authors: Department of Urology, Ludwig-Maximilians-University Munich, Germany.
authors: Julia
authors: J
authors: Grimm
authors: Department of Urology, Ludwig-Maximilians-University Munich, Germany.
authors: Markus
authors: M
authors: Grabbert
authors: Department of Urology, Ludwig-Maximilians-University Munich, Germany.
authors: Friedrich
authors: F
authors: Jokisch
authors: Department of Urology, Ludwig-Maximilians-University Munich, Germany.
authors: Birte-Swantje
authors: BS
authors: Schneevoigt
authors: Department of Urology, Ludwig-Maximilians-University Munich, Germany.
authors: Maria
authors: M
authors: Apfelbeck
authors: Department of Urology, Ludwig-Maximilians-University Munich, Germany.
authors: Gerald
authors: G
authors: Schulz
authors: Department of Urology, Ludwig-Maximilians-University Munich, Germany.
authors: Ricarda M
authors: RM
authors: Bauer
authors: Department of Urology, Ludwig-Maximilians-University Munich, Germany.
authors: Christian G
authors: CG
authors: Stief
authors: Department of Urology, Ludwig-Maximilians-University Munich, Germany.
authors: Alexander
authors: A
authors: Karl
mesh_terms: D000368:Aged; D001955:British Columbia; D003430:Cross-Sectional Studies; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014549:Urinary Incontinence / Q000517:prevention & control*; D016476:Urinary Reservoirs, Continent / Q000502:physiology*; D014563:Urodynamics / Q000502:physiology
keywords: coronary disease; cystectomy; urinary bladder neoplasms; urinary diversion; urinary incontinence