Impact of early self-clean intermittent catheterization in orthotopic ileal neobladder: prospective randomized study to evaluate functional outcomes, continence status and urinary tract infections.

Urinary diversions after radical cystectomy (RC) have a significant impact on quality of life and body image. Particularly for orthotopic neobladder (ONB), the rate of continence, urinary retention and urinary tract infections can impact on patient's quality of life.

The aim of this study is to investigate whether early clean intermittent catheterization (CIC) might improve functional outcomes, continence status, and reduce the incidence of UTIs in patients with ONB.

In this prospective randomized study patients were divided in two groups. Patients were on a standard postoperative care (Group A) or started CIC within the first post-operative month (Group B). All patients were evaluated postoperatively at 1, 3, 6, and 9 months after ONB. The CIC was executed 4 times/daily after each voluntary micturition. The postoperative evaluation included: postvoid residual volume (PVR), urine analysis and culture, number of pads/day and the selfadministrated questionnaire International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF).

39 male and 8 female patients underwent laparoscopic or robotic RC with intracorporeal ONB (37 U shaped and 10 Padua reconstructions). At the first follow up, mean PVR was in group A and B, 136.5 mL and 125.7 ml (p value: 0.105), respectively. The ICIQ-UI SF mean score was 16.2 and 17.1 (p value: 0.243) respectively and the mean no. of pads/day was 3 in both groups. 15 patients in group A and 10 in group B reported episodes of symptomatic UTIs. At 3, 6 and 9 months follow up after surgery the PVR and the ICIQ-UI SF scores were significantly improved (p value < 0.0001). The number of pads decreased to 2 pads/day in group A and 1 in group B at 9 months. The episodes of UTIs significantly decreased over the time (p value < 0.0001).

Our data support the early introduction of self CIC in patients with ONB after RC. The CIC was significantly associated a reduced risk of incontinence, urinary retention, and UTI with significant improvement in QoL. These encouraging data need to be confirmed by further investigations with a larger number of patients.

Minerva urology and nephrology. 2022 Oct 05 [Epub ahead of print]

Yazan Al Salhi, Andrea Fuschi, Alessia Martoccia, Cosimo DE Nunzio, Giogrio Bozzini, Alessandro Sciarra, Martina Maggi, Ester Illiano, Elisabetta Costantini, Anastasios Asimakopoulos, Antonio Carbone, Antonio L Pastore

Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy., Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy., Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy., Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy., Department of Surgical and Biomedical Science, Andrological and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy., Department of Urology, Tor Vergata University, Rome, Italy., Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy - .

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