Long-term functional outcomes after radical cystectomy with ileal bladder substitute: does the definition of continence matter?
OBJECTIVE
Functional outcomes after ileal bladder substitution reflect the expectations of future patients at a particular centre. The aim of this study was to use validated questionnaires and a pad-weighing test to investigate functional outcomes after neobladder reconstruction at long-term follow-up in patients at a single centre.


METHODS
During 2005 - 2015, 75 patients received a Studer ileal bladder substitute at the Department of Urology, Malmö. Forty-six of these patients were alive for follow-up and were evaluated using the pad-weighing test and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF).


RESULTS
Five of 37 evaluable patients (14%) were considered fully continent, reporting a pad-weighing test result of 0 g and an ICIQ-UI-SF score of 0. The median ICIQ-UI-SF score was 8 [interquartile range (IQR) 3-11], and seven patients (17%) were continent according to the ICIQ-UI-SF score only. In the pad-weighing test, 28 out of 37 patients (76%) reported 0 g day-time leakage whereas only 12 out of 37 patients (32%) reported 0 g night-time leakage. At follow-up, nine out of 39 (23%) of evaluable male patients were potent. The median ICIQ-UI-SF score was significantly lower during the second half of the study period [4 (IQR 0-8) vs 10 (IQR 6-14); p = .003]. The inverse applied to the median IIEF score [5 (IQR 3-12) vs 2 (IQR 1-4); p = .02].


CONCLUSIONS
Functional outcomes at long-term follow-up after radical cystectomy and Studer ileal bladder substitute were at best modest in this series. Better outcomes during the second half of the study period might be explained by improved patient selection and a refined surgical technique, but possibly also by longer follow-up of patients during the first half of the period resulting in a more pronounced time-dependent decline in functional outcomes.
a Department of Urology , Skåne University Hospital, Lund University , Malmö , Sweden.|b Department of Translational Medicine , Lund University , Malmö , Sweden.
Fredrik
F
Liedberg
a Department of Urology , Skåne University Hospital, Lund University , Malmö , Sweden.|b Department of Translational Medicine , Lund University , Malmö , Sweden.
Göran
G
Ahlgren
a Department of Urology , Skåne University Hospital, Lund University , Malmö , Sweden.
Gediminas
G
Baseckas
b Department of Translational Medicine , Lund University , Malmö , Sweden.|c Department of Urology , Landspitali University Hospital , Reykjavik , Iceland.
Sigurdur
S
Gudjonsson
a Department of Urology , Skåne University Hospital, Lund University , Malmö , Sweden.
Ulf
U
Håkansson
a Department of Urology , Skåne University Hospital, Lund University , Malmö , Sweden.
Sara
S
Lindquist
a Department of Urology , Skåne University Hospital, Lund University , Malmö , Sweden.|b Department of Translational Medicine , Lund University , Malmö , Sweden.
Annica
A
Löfgren
a Department of Urology , Skåne University Hospital, Lund University , Malmö , Sweden.|b Department of Translational Medicine , Lund University , Malmö , Sweden.
Oliver
O
Patschan
a Department of Urology , Skåne University Hospital, Lund University , Malmö , Sweden.
Carina
C
Siller
a Department of Urology , Skåne University Hospital, Lund University , Malmö , Sweden.|b Department of Translational Medicine , Lund University , Malmö , Sweden.
Gottfrid
G
Sjödahl
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D007172:Erectile Dysfunction / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D016496:Incontinence Pads; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D057566:Self Report; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000209:etiology; D016476:Urinary Reservoirs, Continent
Continence; ICIQ-UI-SF; IIEF; functional outcome; neobladder; potency; radical cystectomy