Predictors of Need for Catheterization and Urinary Retention after Radical Cystectomy and Orthotopic Neobladder in Male Patients.

To investigate the prevalence of catheterization and urinary retention in male bladder cancer patients after radical cystectomy and orthotopic neobladder and to identify potential predictors.

Using an IRB approved, prospectively maintained bladder cancer database, we collected information using a diversion-related questionnaire from 299 consecutive male bladder cancer patients upon postoperative clinic visit. Urinary retention was defined as 3 or more catheterizations per day or a self-reported inability to void without a catheter. Univariable and multivariable Cox regression analysis was performed to identify predictors of catheterization and urinary retention.

Self-catheterization was reported in 51 patients (17%), of whom, 22 (7.4% of the total patients) were in retention. The 3, 5, and 10-year freedom from any catheterization after surgery was 85%, 77% and 62%, respectively. Freedom from retention 3, 5, and 10-years after surgery was 93%, 88% and 79%, respectively. Multivariable Cox regression showed that higher BMI (≥27) significantly increased the need for catheterization (HR 2.34, 95% CI 1.26 - 4.32) as well as retention (HR 5.20, 95% CI 1.74 -15.51). Greater medical comorbidity (CCMI≥2) correlated with the need for any catheterization (HR 1.84, 95%CI 1.02 - 3.3) but not retention. Pathologic stage and type of diversion were not significant predictors of the need to catheterize or urinary retention.

In males undergoing radical cystectomy with orthotopic neobladder, retention requiring catheterization to void is uncommon. Patients with BMI≥27 are at significantly increased risk of retention and need for self-catheterization.

BJU international. 2020 Dec 21 [Epub ahead of print]

Saum Ghodoussipour, Seyedeh Sanam Ladi Seyedian, Daniel Jiang, Jacob Lifton, Hamed Ahmadi, Kevin Wayne, Gus Miranda, Jie Cai, Hooman Djaladat, Anne Schuckman, Sumeet Bhanvadia, Siamak Daneshmand

Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA.