ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2023 February;75(1):59-65

DOI: 10.23736/S2724-6051.22.04944-8

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

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

Yazan AL SALHI ¹, Andrea FUSCHI ¹, Alessia MARTOCCIA ¹, Cosimo DE NUNZIO ², Bozzini GIORGIO ³, Alessandro SCIARRA ⁴, Martina MAGGI ⁴, Ester ILLIANO ⁵, Elisabetta COSTANTINI ⁵, Anastasios ASIMAKOPOULOS ⁶, Antonio CARBONE ¹, Antonio L. PASTORE ¹ ✉

¹ Unit of Urology, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy; ² Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy; ³ Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy; ⁴ Department of Urology, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy; ⁵ Department of Surgical and Biomedical Science, Andrological and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy; ⁶ Department of Urology, Tor Vergata University, Rome, Italy

BACKGROUND: 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 was to investigate whether early clean intermittent catheterization (CIC) might improve functional outcomes, continence status, and reduce the incidence of UTIs in patients with ONB.
METHODS: 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 postoperative 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: post-void residual volume (PVR), urine analysis and culture, number of pads/day and the self-administrated questionnaire International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF).
RESULTS: Thirty-nine 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).
CONCLUSIONS: 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.

KEY WORDS: Cystectomy; Urinary bladder neoplasms; Urinary tract infections