Anceschi Umberto, Di Maida Fabrizio, Chiacchio Giuseppe, Mastroianni Riccardo, Tuderti Gabriele, Lambertini Luca, Albisinni Simone, Mattioli Manuela, Cadenar Anna, Flammia Rocco Simone, Nardoni Samuele, Prata Francesco, Rosato Eleonora, Valastro Francesca, Brassetti Aldo, Bacchiani Mara, Asimakopoulos Anastasios, Salamone Vincenzo, Basile Salvatore, Giudici Sofia, D'Ippolito Giulia, Grosso Antonio Andrea, Tufano Antonio, Licari Leslie, Bologna Eugenio, Mari Andrea, Tuccio Agostino, Finazzi Agrò Enrico, De Nunzio Cosimo, Papalia Rocco, Leonardo Costantino, Minervini Andrea, Simone Giuseppe
Department of Urologic Oncology, IRCCS "Regina Elena" National Cancer Institute (NCI), Rome, Italy.
Department of Urology, "AOU Careggi" - University of Florence, Florence, Italy.
Neurourol Urodyn. 2025 Aug;44(6):1255-1263. doi: 10.1002/nau.70078. Epub 2025 May 19.
A comprehensive scoring system for standardizing quality of functional outcomes of orthotopic ileal neobladders (OINs) is still unavailable. In this study we propose a novel trifecta for both open and robot-assisted radical cystectomy conceived on urodynamic parameters that summarize OINs functional outcomes regardless of the surgical technique used and predicts continence status.
MATERIALS & METHODS: Between June 2017 and May 2023 two prospective, institutional review board approved, radical cystectomy datasets were matched and queried for "OINs" "and "urodynamic evaluation" (n = 149). Urodynamic assessment was performed between 6 and 9 months after surgery. Baseline data and complete urodynamic profile including uroflowmetry, cystometry, compliance, presence of residual peristaltic activity, abdominal leak point pressures (ALPP) and daytime and night-time continence were reported. Descriptive analyses were used. Frequencies and proportions were reported for categorical variables while medians and interquartile ranges (IQRs) were reported for continuously coded variables. Trifecta was defined as the coexistence of: cystometric capacity ≥ 250 cc; neobladder compliance ≥ 35 cmH0; negative Valsalva and abdominal leak point pressure testing. Simultaneous achievement of only two of the presented criteria was considered a suboptimal result. Logistic regression analyses were built to identify predictors of daytime and night-time urinary continence. For all analyses, a two-sided p < 0.05 was considered significant.
Overall, at a median follow-up of 25 months (IQR 16-37), 149 patients achieved a complete urodynamic evaluation. In the current series, the complete trifecta rate was 40.2% while a suboptimal trifecta achievement was observed in 35.6% of patients. On multivariable analysis, complete trifecta achievement was the only independent predictor of daytime (OR 7.29, 95% CI 2.05-25.9) and night-time (OR 8.13; 95% CI 2.94-22.4) urinary continence, respectively (each p < 0.003). A complete UDM-T at urodynamic testing was associated with a day-time continence, night-time continence, and complete dry status rates of 93.2%, 83.1%, and 79.7%, respectively.
This novel urodynamic trifecta for OINs is based on standardized parameters and seems to be predictor of either daytime or night-time urinary continence at a midterm follow-up. Satisfactory continence outcomes may be also expected when a suboptimal trifecta rate is achieved.
Not applicable.
目前仍缺乏用于标准化原位回肠新膀胱（OINs）功能结局质量的综合评分系统。在本研究中，我们基于尿动力学参数提出了一种适用于开放和机器人辅助根治性膀胱切除术的新型三联指标，该指标可总结OINs的功能结局，而不受所采用手术技术的影响，并能预测控尿状态。
2017年6月至2023年5月期间，两个经机构审查委员会批准的前瞻性根治性膀胱切除术数据集进行匹配，并查询“OINs”和“尿动力学评估”（n = 149）。尿动力学评估在术后6至9个月进行。报告基线数据和完整的尿动力学资料，包括尿流率、膀胱测压、顺应性、残余蠕动活动情况、腹压漏尿点压力（ALPP）以及白天和夜间控尿情况。采用描述性分析。分类变量报告频率和比例，连续编码变量报告中位数和四分位数间距（IQR）。三联指标定义为同时具备：膀胱测压容量≥250 cc；新膀胱顺应性≥35 cmH₂O；Valsalva试验和腹压漏尿点压力测试结果为阴性。仅同时满足上述两个标准被视为次优结果。构建逻辑回归分析以确定白天和夜间尿失禁的预测因素。所有分析中，双侧p < 0.05被认为具有统计学意义。
总体而言，中位随访25个月（IQR 16 - 37）时，149例患者完成了完整的尿动力学评估。在本系列中，完全达到三联指标的比例为40.2%，而35.6%的患者达到次优三联指标。多变量分析显示，完全达到三联指标是白天（OR 7.29，95% CI 2.05 - 25.9）和夜间（OR 8.13；95% CI 2.94 - 22.4）尿失禁的唯一独立预测因素（p均< 0.003）。尿动力学测试时完全达到UDM - T与白天控尿、夜间控尿和完全干爽状态的比例分别为93.2%、83.1%和79.7%。
这种用于OINs的新型尿动力学三联指标基于标准化参数，在中期随访中似乎是白天或夜间尿失禁的预测指标。即使达到次优三联指标比例，也可能预期获得满意的控尿结局。
不适用。
