MP65-13: DOES EARLY INTRODUCTION OF SELF INTERMITTENT CATHETERIZATION IMPROVE FUNCTIONAL OUTCOMES AND URINARY INFECTION IN ORTHOTOPIC ILEAL NEOBLADDER? RESULTS FROM A PROSPECTIVE MULTICENTRE STUDY
Introduction: Orthotopic neobladder (ONB) is the preferred urinary diversion after radical cystectomy (RC), although its relate quality-of-life improvements are still under discussion. The principal factors associated with decrease in quality of life are continence status (both incontinence as well as urinary retention) and urinary tract infections (UTIs). The aim of this study is to investigate whether early clean intermittent catheterization (CIC) might improve functional outcomes, continence status, and reduce the incidence of UTIs. Methods: In this study, patients were prospectively randomized in two groups. Patients that were on a standard postoperative care(Group A)or subjects that started CIC within the first post-operative 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: postvoid residual volume(PVR), urine analysis and culture, number of pads/day and the selfadministrated questionnaire International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form(ICIQ-UI SF). Results: From September 2017 to March 2021, 39 male and 8 female patients underwent laparoscopic or robot assisted RC with totally intracorporeal ONB (37 U shaped and 10 Padua reconstructions). All patients completed the nine months follow-up(mean 9.2 months; range 6-13 months). At the first follow up all patients were able to do self CIC. At this time mean PVR was 116.5 mL, ICIQ-UI SF mean score was 16, mean no. of pads/day was 3, 14 patients reported 3 episodes of symptomatic UTIs (Escherichia coli was the most common pathogen). At 3, 6 and 9 months follow up after surgery the PVR and the ICIQ-UI SF scores were significantly improved. The number of pads decreased to 2 pads/day at 3 months, and only one safety pad at 6 and 9 months. The episodes of UTIs significantly decreased over the time with only 8 patients at 3 months (reporting 4 symptomatic episodes), and 4 and two patients at 6 and 9 months, respectively. Conclusions: Our data strongly 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. SOURCE OF Funding: None
