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Cakmak S, Canda AE, Ener K, Atmaca AF, Altinova S, Balbay MD. Does Type 2 Diabetes Mellitus Have an Impact on Postoperative Early, Mid-Term and Late-Term Urinary Continence After Robot-Assisted Radical Prostatectomy? J Endourol 2019; 33:201-206. [PMID: 30648427 DOI: 10.1089/end.2018.0822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We evaluated the effect of diabetes mellitus (DM) on urinary continence after robotic radical prostatectomy (RARP). PATIENTS AND METHODS Overall, 99 patients with DM and 213 patients without DM who underwent RARP with at least 2-year follow-up were included. The preoperative prostate biopsy Gleason scores and clinical stages of the groups were similar. The patients who were dry or used one safety pad per day were regarded as continent. Early (0-3 months), mid-term (4-12 months), and late-term (>12 months) continence rates were evaluated. RESULTS In diabetic and nondiabetic groups, mean age was 63.3 ± 6.5 and 61.3 ± 6.8 years, respectively (p = 0.015). On the day of the removal of the urethral catheter, 61.6% (n = 61) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At third-month follow-up, 80.8% (n = 80) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At sixth-month follow-up, 89.9% (n = 89) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At first-year follow-up, 93.9% (n = 93) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.001). At 18th-month follow-up, 96.0% (n = 95) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.013). At second-year follow-up, 98.0% (n = 97) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.115). Multivariate analysis showed that age and body mass index had no impact on urinary continence (p > 0.05). Presence of diabetes (p = 0.008) and duration (≥5 years) of diabetes (p = 0.004) were independent factors that had a significant negative impact on urinary continence. CONCLUSIONS Diabetes seems to be a significant disadvantage in gaining urinary continence compared with nondiabetic patients particularly in the first 18 months after RARP. Diabetic patients should be informed about possible late recovery of postoperative urinary continence compared with nondiabetic patients after RARP.
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Affiliation(s)
- Serdar Cakmak
- 1 Urology Clinics, Ordu State Hospital, Ordu, Turkey
| | | | - Kemal Ener
- 3 Department of Urology, University of Health Sciences Affiliated with Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ali Fuat Atmaca
- 4 Department of Urology, School of Medicine Affiliated with Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Serkan Altinova
- 5 Department of Urology, School of Medicine, Liv Hospital, Istinye University, Ankara, Turkey
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Nayak AL, Cagiannos I, Lavallée LT, Morash C, Hickling D, Mallick R, Breau RH. Urinary function following radical cystectomy and orthotopic neobladder urinary reconstruction. Can Urol Assoc J 2018; 12:181-186. [PMID: 29485037 DOI: 10.5489/cuaj.4877] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION An orthotopic neobladder urinary diversion aims to minimize the physical and psychological effects of radical cystectomy through avoidance of a stoma and maintenance of urethral voiding. Neobladder function reported in the literature ranges widely due to differences in patient selection and method of assessment. The objective of the study was to characterize functional outcomes of consecutive patients treated at a tertiary care hospital. METHODS A historical cohort of patients who underwent radical cystectomy with a neobladder diversion performed at The Ottawa Hospital between January 2006 and December 2014 were reviewed. Outcomes of interest were urinary continence, use of clean intermittent catheterization (CIC), post-void residual volume, and uroflowmetry at three, six, and 12 months following cystectomy. RESULTS During the study period, 158 neobladder diversions were performed. The mean age of patients was 63.1 years (standard deviation [SD] 8.1), and 81.7% were male. Significant daytime incontinence (>1 pad) three months following surgery was common (65%), but decreased to 8.6% by 12 months. Nighttime incontinence was also common at three months (54%) and improved at 12 months (20%). While no appreciable differences between men and women were observed for continence, more women performed CIC at 12 months post-surgery (59% of women; 9% of men; relative risk [RR] 0.15; 95% confidence interval [CI] 0.07-0.30). Among patients who did not catheterize, uroflowmetry and post-void residual volume parameters were stable between three and 12 months postoperative. CONCLUSIONS Daytime and nighttime incontinence is common in neobladder patients following surgery, but improves considerably with time. Correspondingly, many female neobladder patients at our institution use CIC.
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Affiliation(s)
- Ameeta L Nayak
- The Ottawa Hospital Research Institute; University of Ottawa, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
| | - Chris Morash
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- The Ottawa Hospital Research Institute; University of Ottawa, Ottawa, ON, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
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Chronic urinary retention after radical cystectomy and orthotopic neobladder in women: Risk factors and relation to time. Urol Oncol 2017; 35:671.e11-671.e16. [DOI: 10.1016/j.urolonc.2017.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/19/2017] [Accepted: 07/31/2017] [Indexed: 11/18/2022]
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Patients with an Orthotopic Low Pressure Bladder Substitute Enjoy Long-Term Good Function. J Urol 2016; 196:1172-80. [PMID: 27140070 DOI: 10.1016/j.juro.2016.04.072] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Orthotopic bladder substitution has been performed on a regular basis for more than 30 years and yet data on long-term functional outcomes are still lacking. MATERIALS AND METHODS We evaluated 181 men and 19 women who underwent radical cystectomy and urinary diversion with ileal orthotopic bladder substitution from 1985 to 2004 and who had 10 years or more of followup. RESULTS Median age at radical cystectomy was 63 years (IQR 57-69). Median followup was 167 months (IQR 137-206). Daytime and nighttime continence rates peaked 24 months postoperatively and decreased slightly thereafter during almost 2 decades. At 10, 15 and 20 years daytime continence rates were 92%, 90% and 79%, and nighttime continence rates were 70%, 65% and 55%, respectively. During the day and at night fewer than 3% and 10% of patients, respectively, had urine loss 100 ml or greater at any time 10 years or longer after surgery. At 10 and 20 years 11 of 200 patients (6%) and 1 of 29 (3%), respectively, had to perform clean intermittent self-catheterization. After an initial postoperative decrease in the estimated glomerular filtration rate the subsequent decrease was less than 1 ml/minute/1.73 m(2) per year. A total of 81 complications were observed in 42 of the 200 patients (21%) 10 years or longer after radical cystectomy with pyelonephritis as the most frequent cause. CONCLUSIONS Patients who survive up to 20 years after radical cystectomy and diversion with an ileal orthotopic bladder substitution may enjoy satisfactory urinary continence and retain the ability to void spontaneously while experiencing no more than a physiological decrease in renal function.
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Superior Functional Outcome after Radical Cystectomy and Orthotopic Bladder Substitution with Restrictive Intraoperative Fluid Management: A Followup Study of a Randomized Clinical Trial. J Urol 2015; 193:173-8. [DOI: 10.1016/j.juro.2014.07.109] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2014] [Indexed: 11/22/2022]
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Paananen I, Ohtonen P, Perttilä I, Jonsson O, Edlund C, Wiklund P, Ljungberg B, Möller-Jensen K, Jonsson E, Månsson W. Functional results after orthotopic bladder substitution: a prospective multicentre study comparing four types of neobladder. Scand J Urol 2013; 48:90-8. [PMID: 23863091 DOI: 10.3109/21681805.2013.799225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate enterocystometry, voiding pattern and urine leakage of four types of orthotopic bladder substitute. MATERIAL AND METHODS At eight urological departments, 78 consecutive men were studied: 66 with an ileal neobladder [30 Studer pouches (S), 24 Hautmann pouches (H) and 12 T-pouches (T)] and 12 with a right colonic [Goldwasser type (G)] neobladder. Enterocystometry, determination of residual urine, micturition protocol and 24 h pad weight test were performed 6 and 12 months postoperatively. RESULTS Colonic neobladders had higher pouch pressure at first desire, normal desire and strong desire than ileal neobladders (except at first and normal desire at 12 months) (p < 0.02) and contraction was present more often at both 6 and 12 months (p < 0.01 and p < 0.01). Compliance was good in all types of pouch. Intermittent self-catheterization was more common in H patients at 6 months (p = 0.033). All patients with colonic neobladders used pads during the day and night. In patients with ileal pouches 32% used pads during the day and 70% during the night at 12 months. Urine leakage was higher in patients with colonic bladders at 6 and 12 months during the day (mean/median of 98/31 ml and 82/16 ml versus 10/0 ml and 4/0 ml, p < 0.001). T-pouches had excellent day-time continence, but nocturnal leakage was high. CONCLUSIONS The Hautmann pouch and the Studer pouch behaved similarly at enterocystometry and clinically, and continence was good in the majority of patients. The low number of patients with the other two types of pouch precludes definitive statements.
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Affiliation(s)
- Ilkka Paananen
- 1 Department of Urology, Oulu University Hospital , Oulu , Finland
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Ahmadi H, Skinner EC, Simma-Chiang V, Miranda G, Cai J, Penson DF, Daneshmand S. Urinary Functional Outcome Following Radical Cystoprostatectomy and Ileal Neobladder Reconstruction in Male Patients. J Urol 2013; 189:1782-8. [DOI: 10.1016/j.juro.2012.11.078] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Hamed Ahmadi
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - Eila C. Skinner
- Department of Urology, Stanford University, Stanford, California
| | - Vannita Simma-Chiang
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - Gus Miranda
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - Jie Cai
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Siamak Daneshmand
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
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Zhu Z, Zhang X, Shen Z, Zhong S, Wang X, Lu Y, Xu C. Diabetes mellitus and risk of bladder cancer: a meta-analysis of cohort studies. PLoS One 2013; 8:e56662. [PMID: 23437204 PMCID: PMC3577653 DOI: 10.1371/journal.pone.0056662] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 01/12/2013] [Indexed: 12/11/2022] Open
Abstract
Background Increasing evidence suggests that diabetes mellitus (DM) may be associated with an increased risk of bladder cancer. To provide a quantitative assessment of this association, we evaluated the relation between DM and incidence and mortality of bladder cancer in an updated meta-analysis of cohort studies. Methods We identified cohort studies by searching the EMBASE and MEDLINE databases, through 31 March 2012. Summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated with random-effects models. Results A total of 29 cohort studies (27 articles) were included in this meta-analysis. DM was associated with an increased incidence of bladder cancer (RR 1.29, 95% CI: 1.08–1.54), with significant evidence of heterogeneity among these studies (p<0.001, I2 = 94.9%). In stratified analysis, the RRs of bladder cancer were 1.36 (1.05–1.77) for diabetic men and 1.28 (0.75–2.19) for diabetic women, respectively. DM was also positively associated with bladder cancer mortality (RR 1.33, 95% CI: 1.14–1.55), with evident heterogeneity between studies (p = 0.002, I2 = 63.3%). The positive association was observed for both men (RR 1.54, 95% CI: 1.30–1.82) and women (RR 1.50, 95% CI: 1.05–2.14). Conclusion These findings suggest that compared to non-diabetic individuals, diabetic individuals have an increased incidence and mortality of bladder cancer.
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Affiliation(s)
- Zhaowei Zhu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaohua Zhang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhoujun Shen
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- * E-mail: (ZS); (YL)
| | - Shan Zhong
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xianjin Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- * E-mail: (ZS); (YL)
| | - Chen Xu
- Department of Embryology and Histology, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Reproductive Medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Abstract
Orthotopic urinary diversion (OUD) is performed in almost half of all radical cystectomies. This review presents an overview of the incidence, pathophysiology, and management of urinary incontinence (UI) after OUD. Daytime and nighttime UI are reported in up to 15% and 45% of cases after OUD, respectively. UI after OUD is more frequent in women. Stress incontinence is the most common reason for daytime urinary leakage, while an absent vesicourethral reflex with reduced external sphincter muscle tone is associated with nighttime UI. Conservative management has limited therapeutic value in UI after OUD. Surgical approaches include adjustable and nonadjustable slings as well as the ProACT® system in mild stress UI. Implantation of the artificial urinary sphincter system AMS 800® is the standard treatment for stress UI after OUD. Very limited data exist regarding results after implantation of newer artificial urinary sphincter systems such as the FlowSecure® and the Zephyr® ZSI 375 after OUD.
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Wang WG, Zhong H, Yu B, Tang JE, Chen Y, Cao M, Jin XD. Modified orthotopic spiral ileal bladder substitution: surgical technique and long-term results. Urol Oncol 2012; 31:1599-605. [PMID: 22481020 DOI: 10.1016/j.urolonc.2012.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 02/17/2012] [Accepted: 02/17/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objectives of this study are to introduce the surgical technique of a modified spiral orthotopic ileal neobladder and to assess the long-term outcomes. PATIENTS AND METHODS Between January 1998 and January 2006, 44 male and 7 female patients with bladder cancer received radical cystectomy (RC) and pelvic lymphadenectomy. An ileal segment 40 cm to 45 cm long was isolated to create a spiral orthotopic ileal neobladder, and the ureters were implanted into the reservoir using a non-refluxing split-cuff nipple technique. Preoperative, perioperative, and postoperative data were collected. Complications were classified as early (less than 3 months after surgery) or late (more than 3 months after surgery). Continence incidence and urodynamic studies were evaluated 5 years after surgery. Duration of follow-up was an average of 95 months (range 60-156 months). RESULTS There were no perioperative deaths. The mean operative time was 315 ± 34 minutes. The mean blood loss was 783 ± 316 ml. There were 31 early complications in 21 patients (41%) and 42 late complications in 30 patients (59%). Urodynamic studies showed the maximum neobladder capacity to be 500 ± 71 ml, maximum flow rate to be 16 ± 5 ml/s and post-voiding residual (PVR) to be 50 ± 44 ml. Postoperative continence was excellent with a daytime continence rate of 90% and a nocturnal continence rate of 78% 5 years after surgery. CONCLUSIONS The modified spiral neobladder is easy to perform and allows for excellent long-term results with regard to complications and continence.
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Affiliation(s)
- Wei-Gao Wang
- Department of Urology, The First People's Hospital of Huzhou, Affiliated Hospital of Huzhou Teachers' College, Huzhou, P.R. China
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Teber D, Sofikerim M, Ates M, Gözen AS, Güven O, Sanli O, Rassweiler J. Is type 2 diabetes mellitus a predictive factor for incontinence after laparoscopic radical prostatectomy? A matched pair and multivariate analysis. J Urol 2010; 183:1087-91. [PMID: 20092834 DOI: 10.1016/j.juro.2009.11.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE We evaluated the effect of diabetes mellitus on incontinence after laparoscopic radical prostatectomy. MATERIALS AND METHODS From a series of 2,071 patients 135 with type 2 diabetes mellitus undergoing laparoscopic radical prostatectomy without radiotherapy and with a minimum followup of 24 months were identified. These patients were randomly matched with 135 nondiabetic controls for age, body mass index, preoperative prostate specific antigen, clinical stage, neoadjuvant hormonal therapy, prostate volume, previous surgery, surgeon skills, surgical approach, presence of bladder neck sparing, lymphadenectomy, technique of urethrovesical anastomosis and attempted nerve sparing surgery. RESULTS Using multivariate analysis age, diabetes mellitus and duration of diabetes mellitus were independent factors for post-prostatectomy incontinence in the whole group. Early continence (0 to 3 months) was observed in 43.7% of patients with diabetes and in 57.8% of nondiabetic controls which was statistically significant (p = 0.02). The rates of continence in patients with diabetes mellitus for 5 or more years at 3, 12 and 24-month evaluations were less than those in patients with diabetes mellitus for less than 5 years, and the difference was statistically significant (36% vs 50%, p = 0.001; 63.9% vs 82.4%, p = 0.02; 91.8% vs 98.6%, p = 0.03, respectively). CONCLUSIONS Patients with type 2 diabetes mellitus need longer to recover continence than nondiabetics after laparoscopic radical prostatectomy. However, type II diabetes mellitus did not affect overall return to continence. Patients with diabetes mellitus for 5 or more years have an almost 5 times increased risk of post-prostatectomy incontinence compared to those with diabetes mellitus for less than 5 years. Diabetic patients should be counseled for the potential negative impact of diabetes mellitus on the recovery of continence after laparoscopic radical prostatectomy.
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Affiliation(s)
- Dogu Teber
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
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Editorial comment on: diabetes mellitus: does it impair urinary continence after radical cystoprostatectomy and ileal orthotopic bladder substitution? Eur Urol 2007; 53:1046-7. [PMID: 17935876 DOI: 10.1016/j.eururo.2007.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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