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Chronic urinary retention after radical cystectomy and orthotopic neobladder in women: Risk factors and relation to time

Urologic Oncology: Seminars and Original Investigations Aug 30, 2017

Zahran MH, et al. – The physicians conducted this work to evaluate the long–term cumulative incidence of chronic urinary retention (CUR) after radical cystectomy (RC) and orthotopic neobladder (ONB) in women and the possible risk factors. The data showed that the incidence of CUR after RC and ONB in women increases with time even after 10 years of follow–up. It was suggested taht presence of diabetes mellitus increases the risk of CUR establishment. In addition, genital–sparing RC and modification to prevent CUR reduced the likelihood of CUR development.

Methods
  • In this retrospective study, researchers prospectively evaluated cohort of women for whom RC and ONB were performed.
  • They assessed patients in CUR for the cumulative incidence of CUR applying Kaplan–Meier curve and for the possible risk factors using log rank and Cox regression analysis.

Results
  • They recruited a sum of 234 women with mean age ± SD of 52.3 ± 9 years and a median (range) of follow–up of 92 (12–247) months.
  • It was noted that the incidence of CUR increased with time, where 12 (5.2%), 21 (8.97%), 35 (14.9%), 53 (22.6%), and 56 (24%) patients started clean intermittent catheterization in 1, 2, 2 to 5 years, 5 to 10 years, and after 10 years of follow–up, respectively.
  • This univariate and multivariate analysis demonstrated that diabetes mellitus and urethral Kock pouch were independent predictors of CUR development (HR [95% CI] = 2.45 [1.2–5.1], and 2.1 [1.05–4.2], P = 0.01 and 0.03, respectively).
  • As per the data, genital– sparing RC and surgical modification to provide pouch back support were independent factors that reduce CUR development (HR [95% CI] = 9.3 [1.25–69.9], and 2.1 [1.19–3.9], P = 0.02 and 0.01, respectively).
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