Functional results following vescica ileale Padovana (VIP) neobladder: midterm follow-up analysis with validated questionnaires

Abstract

Background: Orthotopic bladder reconstruction is the preferred method of urinary diversion following radical cystectomy (RC). Several papers reported functional data of different orthotopic neobladders, although to date, no one has used validated questionnaires.

Objective: To evaluate the midterm functional results in a contemporary series of patients undergoing RC and vescica ileale Padovana (VIP) orthotopic neobladder by applying a set of validated questionnaires.

Design, setting, and participants: We conducted a cross-sectional study at a single academic centre.

Intervention: We included RC and VIP orthotopic techniques for bladder transitional cell carcinoma.

Measurements: The American Urological Association Symptom Index (AUA-SI), the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and the five-item version of the International Index of Erectile Function (IIEF-5) were used to evaluate functional outcomes.

Results and limitations: All 113 patients who were alive and disease free at 44-mo follow-up were evaluated. Sixteen patients (13%) were on clean intermittent catheterisation (CIC). The median AUA-SI score of the 97 voiding patients was 9 (interquartile range [IQR]: 4.5-16). Specifically, 48.5%, 40.2%, and 11.3% of the patients had mild, moderate, or severe lower urinary tract symptoms (LUTS), respectively. American Society of Anaesthesiologists class (odds ratio [OR]: 9.0; p=0.03) and body mass index (OR: 1.5; p=0.023) were independent predictors of the need for CIC, while only patient age at the time of surgery (OR: 0.920; p=0.01) was predictive of LUTS severity. The median ICIQ-UI SF score was 6 (IQR: 3-10). Twenty patients (17.7%) were fully continent, while 31.9%, 35.4%, and 15% had slight, moderate, and severe incontinence, respectively. About 90% of the patients during the day and 80% during the night used no pad or only a safety pad. Most of the patients leaked when asleep. No variable was predictive of return to continence. Finally, roughly 20% of the male patients were potent, having an IIEF-5 score ≥17.

Conclusions: We reported midterm functional outcomes following RC and VIP neobladder using validated questionnaires. On the whole, the results are encouraging. However, in the absence of patient self-completed questionnaires, functional outcomes may be significantly overestimated.