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Impact of Early Self-Clean Intermittent Catheterization in Orthotopic Ileal Neobladder: Prospective Randomized Study to Evaluate Functional Outcomes, Continence Status and Urinary Tract Infections - Beyond the Abstract

Orthotopic neobladder, after radical cystectomy, has the main advantage of preserving body image, whereas improvements in quality of life over ileal conduit are still a matter of debate. Principal factors that might be associated with a decreased quality-of-life are continence status (both incontinence as well as urinary retention) and urinary tract infections (UTIs).

During patient counseling regarding ONB, the possible need for clean intermittent catheterization (CIC) of ileal neobladder must be always discussed.

No previous studies evaluated the impact of early introduction of CIC on quality of life, UTIs, and urinary continence in patients who underwent ONB. The aim of this prospective randomized study is to investigate whether the introduction of clean intermittent catheterization within the first month after ONB reconstruction could impact and improve functional outcomes, and continence status, and might be associated with a reduction of UTIs.

Intermittent catheterization represents a safe, simple, and effective treatment that reduces the incidence of bladder overdistension. CIC minimizes the risk of urinary tract infections, bladder calculi, vesicoureteral reflux and it protects renal function. In our study, the early introduction of CIC at the indwelling catheter removal time in patients with ONB was associated with a reduction of UTIs, PVR, and fast recovery of continence status.

The results of the present study, even limited by the small sample size and short-term follow-up period, represent the first encouraging suggestion that early intermittent catheterization of patients submitted to ONB might be related to better voiding efficiency and bladder emptying with consequent reduced UTIs episodes and improved urinary continence. Larger prospective multicenter studies with longer follow up are needed to confirm the results.

Written by: Antonio L. Pastore, MD, PhD,1 Yazan Al Salhi, MD,1 & Andrea Fuschi, MD2

  1. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy
  2. Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy

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