Functional Results Following Vescica Ileale Padovana (VIP) Neobladder: Midterm Follow-up Analysis with Validated Questionnaires

摘要

Background: Orthotopic bladder reconstruction is the preferred method of urinary diversion following radical cystectomy (RC). Several papers reported functional data of different ortho-topic neobladders, although to date, no one has used validated questionnaires. Objective: To evaluate the midterm functional results in a contemporary series of patients undergoing RC and vescica ileale Padovana (VIP) orthotopic neobladder by applying a set of validated questionnaires. Design, setting, and participants: We conducted a cross-sectional study at a single academic centre. Intervention: We included RC and VIP orthotopic techniques for bladder transitional cell carcinoma. Measurements: The American Urological Association Symptom Index (AUA-SI), the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ.-UI SF), and the five-item version of the International Index of Erectile Function (IIEF-5) were used to evaluate functional outcomes. Results and limitations: All 113 patients who were alive and disease free at 44-mo follow-up were evaluated. Sixteen patients (13%) were on clean intermittent catheterisation (CIC). The median AUA-SI score of the 97 voiding patients was 9 (interquartile range [IQR]: 4.5-16). Specifically, 48.5%, 40.2%, and 11.3% of the patients had mild, moderate, or severe lower urinary tract symptoms (LUTS), respectively. American Society of Anaesthesiologists class (odds ratio [OR]: 9.0; p = 0.03) and body mass index (OR: 1.5; p = 0.023) were independent predictors of the need for CIC, while only patient age at the time of surgery (OR: 0.920; p = 0.01) was predictive of LUTS severity. The median ICIQ.-UI SF score was 6 (IQR: 3-10). Twenty patients (17.7%) were fully continent, while 31.9%, 35.4%, and 15% had slight, moderate, and severe incontinence, respectively. About 90% of the patients during the day and 80% during the night used no pad or only a safety pad. Most of the patients leaked when asleep. No variable was predictive of return to continence. Finally, roughly 20% of the male patients were potent, having an IIEF-5 score >=17. Conclusions: We reported midterm functional outcomes following RC and VIP neobladder using validated questionnaires. On the whole, the results are encouraging. However, in the absence of patient self-completed questionnaires, functional outcomes may be significantly overestimated.