Assessment of voiding function of orthotopic neobladders in elderly patients with long‐term survival

Abstract

OBJECTIVE To compare the voiding status in elderly patients (aged ≥80 years) with that in younger patients undergoing orthotopic neobladder substitution during long‐term survival. PATIENTS AND METHODS The voiding status was assessed in 111 patients (ileal neobladder in 62, ascending colonic neobladder in 14, sigmoid colonic neobladder in 21 and ileocolonic neobladder in 14) who lived for >5 years after radical cystectomy with an orthotopic neobladder, using a self‐completed questionnaire and uroflowmetry. According to the age at the time of these assessments, patients were divided into two groups (group 1, <80 years, 94; group 2, ≥80 years, 17). The voiding status was compared between the groups. RESULTS In all, 78 patients (92%) in group 1 and 16 (94%) in group 2 were capable of spontaneous voiding. In group 1 and 2, respectively, daytime continence was achieved by 67 (74%) and 12 (75%) patients, but night‐time continence was achieved by 54 (60%) and six (38%), although the difference was not statistically significant. In groups 1 and 2, respectively, the median maximum flow rate was 13.3 and 11.7 mL/s and the median postvoid residual urine volume was 19 and 18 mL. The only statistically significant difference was for voiding posture, assessed in men. CONCLUSIONS There was no significant difference in voiding status of patients with orthotopic neobladders except for voiding posture between patients aged <80 or carefully selected elderly patients aged ≥80 years during long‐term survival. However, night‐time continence might be clinically worse in the elderly than in the younger group.

Can we predict the need for clean intermittent catheterization after orthotopic neobladder construction?

“…Our findings are contradictory to other reports that have demonstrated no appreciable differences in voiding function following ONB in the elderly. [ 15 ] Theoretically, this may be a result of younger patients being more physically and mentally capable of long-term CIC compared with elderly patients, who may demonstrate less compliance. Younger patients may have higher expectations and desire to remain completely dry, which may lead them to catheterize as a precautionary tool to keep their bladder empty and prevent incontinence.…”