Diabetes mellitus: does it impair urinary continence after radical cystoprostatectomy and ileal orthotopic bladder substitution?

Abstract

Objective: To assess the effect of diabetes mellitus (DM) on urinary continence after radical cystoprostatectomy and ileal orthotopic bladder substitution.

Methods: Patients with DM undergoing radical cystoprostatectomy and ileal orthotopic bladder substitution without prior radiotherapy and with a minimum follow-up of 12 mo were identified from our database. Twenty-two men met the inclusion criteria and were randomly matched to 22 nondiabetic controls for age, ileum length used for reservoir construction, attempted nerve-sparing surgery, pathologic tumour stage, and pathologic lymph node status to assess the effect of DM on urinary continence.

Results: All 22 diabetic patients suffered from type 2 DM. Twelve were treated with oral antidiabetics and 10 required insulin. Daytime continence was significantly worse in the diabetic patients compared to nondiabetic controls 3 mo (odds ratio [OR] 21; 95% confidence interval [CI], 2.4-185; p=0.001) and 6 mo (OR 17.5; 95% CI, 2-154; p=0.002) postoperatively. Thereafter no significant difference was detectable. In diabetic patients nighttime continence was worse. The difference was statistically significant at 3 mo (OR 7.3; 95% CI, 1.9-28; p=0.002), 6 mo (OR 9.1; 95% CI, 2.3-36; p=0.001), 12 mo (OR 7.1; 95% CI, 1.9-27; p=0.003), and 24 mo (OR 5.7; 95% CI, 1.3-26; p=0.018) after surgery.

Conclusions: Patients with DM take longer to regain daytime and, even more so, nighttime continence than nondiabetic patients. Diabetic patients undergoing radical cystoprostatectomy should be informed of the potential negative impact of DM on the recovery of urinary continence after an ileal orthotopic bladder substitution.