Introduction: Orthotopic neobladder (ONB) following radical cystectomy (RC) is less frequent in female patients compared to males, due to unclear functional outcomes. We prospectively evaluated the continence outcomes in female patients undergoing open RC and ONB with a validated pad usage questionnaire.
Methods: From May 2012 onwards, we prospectively followed patients after open RC with ONB with a validated, pictorial, pad usage questionnaire that assesses the number, size, and wetness of pads, as well as catheter use, at follow-up clinic visits. In our IRB approved database, 42 ONB were performed for female patients after open RC from May 2012 to May 2018 (38% of all urinary diversions in female patients). 32 patients had complete data from interval clinic visits with at least 1 year of follow-up. Daytime continence was defined as no pad usage or an almost dry pad.
Results: A total of 32 female ONB patients with median age of 65 years (range: 42-81) and BMI of 25.6 (range: 18-35) were included. Median follow-up was 3 years (range: 1-7). The need to catheterize was noted in 10 patients (36%), either due to complete retention (7%), high post-void residuals (25%), or to empty their neobladder prior to sleeping (4%). Neobladder-vaginal fistulae developed in 4 patients (14%), with 1 ultimately converting to a continent cutaneous diversion after failed conservative management and the other 3 undergoing primary repairs. Daytime continence rates with and without intermittent catheterization increased from 64% and 36% at 4 months post-operatively, to 90% and 60% at 4 years, respectively. Nighttime continence rates with and without catheterization increased from 57% and 24% at 4 months, to 90% and 60% at 4 years, respectively (Figure1). Daytime continence rate was significantly less in females compared to males (P=0.024), while there was no significant difference in nighttime continence rate between them (P=0.58).
Conclusions: Open RC and ONB in selected female patients can have good functional outcomes. Day and nighttime continence improve over time and majority of patients achieve continence by 2 years. Source of
