Long-term urodynamic evaluation of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer

Abstract

The long-term urodynamics of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer remain unclear in the clinical setting. The present prospective observational study was conducted between January 2010 and December 2012 to evaluate the 6-month and 12-month follow-up data of urodynamic changes of bladder cancer patients who were initially treated by laparoscopic radical cystectomy with orthotopic ileal neobladder. A total of 53 eligible patients were included, and all patients were followed up for at least 12 months, with a median time of 18 months. During the follow-up period, no patients reported difficulty urinating, and the daily frequency of urination and the urine output were gradually improved with time. Dynamic urodynamic examinations showed that the maximum flow rate (11.4±1.1 vs. 7.3±1.4 ml/sec; P<0.001), residual urine content (22.8±10.5 vs. 40.7±12.7 ml; P<0.001), maximum bladder capacity (373.8±62.2 vs. 229.7±56.3 ml; P<0.001) and maximum bladder pressure during filling (35.8±6.7 vs. 26.4±7.0 cm H2O; P<0.001) at 12 months were all improved significantly compared with that at 6 months after the initial surgical treatment. However, there were no significant differences in maximum bladder pressure during voiding (75.7±24.7 vs. 73.1±24.7 cm H2O; P=0.618) and bladder compliance (26.9±13 vs. 27.4±13.1 cm H2O; P=0.848) at 12 and 6 months after initial surgical treatment. In conclusion, the urodynamics of this orthotopic ileal neobladder gradually improve, and its long-term urine storage and voiding functions are acceptable.

Cluster analysis identifies three urodynamic patterns in patients with orthotopic neobladder reconstruction

“…Second, due to its retrospective nature, the postoperative time interval of the urodynamic test was not consistent and relatively short. Considering that urodynamic profiles improve during the first year after surgery [ 3 , 33 ], urodynamic tests at an early postoperative time may not reflect the matured functional state of orthotopic neobladder. We commonly performed urodynamic tests at 3–6 months after surgery as comprehensive urodynamic evaluation and for early intervention of voiding dysfunction.…”

Febrile Urinary Tract Infection after Radical Cystectomy with Urinary Diversion: Different Characteristics in Patients with Ileal Conduit and Orthotopic Neobladder

“…In addition, serial urodynamic examinations in patients with neobladders presented that a significant increase in maximal � ow rate and bladder capacity concomitant to a decrease in residual urine volume were documented over a 6-month interval from surgery, possibly contributing to the decrease in UTI events. 19 Third, excessive mucus production by the bowel epithelium accompanied by an established infection can prevent effective clearance of microorganisms. However, after 3-6 months after surgery, atrophic changes in the intestinal mucosa lining the neobladder occur, and consequently, the neobladder is less susceptible to bacterial colonization and infection.…”

Urodynamic Parameters and Continence Outcomes in Asymptomatic Patients with Ileal Orthotopic Neobladder: A Systematic Review and Metanalysis

“…The vast majority of articles included in our SR were retrospective, with only a few (28.8%) prospective trials [8,12,13,15,[21][22][23]25,33,46,48,49,53,60,[63][64][65]. Only 13 (22%) report institutional review board approval [8,[13][14][15][20][21][22]25,33,40,53,64,65].…”

“…Thirty-five out of 59 studies (59.3%) included patients of both sexes; 19 (54.3%) reported only males; and 5 (14.3%) studied only female patients. Comorbidities were reported in eight studies [7,8,13,30,37,53,64,65]. Time of follow-up is reported in 44 (74.6%) studies, but in 15 (23.4%) studies, this data is lacking [7,9,19,23,32,36,39,41,43,46,48,51,53,60,61].…”

“…Comorbidities were reported in eight studies [7,8,13,30,37,53,64,65]. Time of follow-up is reported in 44 (74.6%) studies, but in 15 (23.4%) studies, this data is lacking [7,9,19,23,32,36,39,41,43,46,48,51,53,60,61]. Follow-up ranges from a minimum of 5 months [35] to 179.2 months [31], for a mean value of 42.7 months and a median value of 32.9 (25-75th percentile: 19 to 60.5 months).…”