Nerve‐sparing radical cystectomy has a beneficial impact on urinary continence after orthotopic bladder substitution, which becomes even more apparent over time. (4th February 2018)

• Record Type: Journal Article
• Authors: Furrer, Marc A.; Studer, Urs E.; Gross, Tobias; Burkhard, Fiona C.; Thalmann, George N.; Nguyen, Daniel P.
• Is Part Of: BJU international. Volume 121:Number 6(2018)
• Page Start: 935
• Page End: 944
• Publication Date: 2018-02-04
• Subjects: cystectomy -- orthotopic bladder substitute -- nerve sparing -- urinary continence; Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.14123
• Languages: English
• ISSNs: 1464-4096

Abstract

Abstract : Objective: To analyse urinary continence in long‐term survivors after radical cystectomy (RC) and orthotopic bladder substitution (OBS) according to attempted nerve‐sparing (NS) status. Patients and Methods: We analysed 180 consecutive patients treated at our department between 1985 and 2007, who underwent RC with OBS, and survived ≥10 years after RC. We stratified patients by attempted NS status and evaluated continence outcomes using descriptive statistics and Cox proportional hazards regression models. A secondary analysis evaluated erectile function as a quality control for attempted NS. Results: The median (interquartile range [IQR]) age at RC was 62 (57−71) years. Of 180 patients, attempted NS status was none in 24 (13%), unilateral in 100 (56%), and bilateral in 56 (31%). After a median (IQR) follow‐up of 169 (147−210) months, 160 (89%) patients were continent during daytime and 124 (69%) during night‐time. In multivariable analysis, any degree of attempted NS was significantly associated with daytime continence (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.05–4.11; P = 0.04). Correspondingly, any attempted NS was significantly associated with night‐time continence (OR 2.51, 95% CI 1.08–5.85; P = 0.03). Recovery of erectile function at 5 years was also significantly associated with attempted NS ( P < 0.001). Conclusion: Nerve‐sparing during RC and OBS was associated with better long‐term continence outcomes. This becomes more apparent as the patients age with their OBS. We advocate a NS RC whenever an OBS is considered.