Efficacy of bundle care for improving urinary control in patients after orthotopic ileal neobladder reconstruction

Abstract

Objective To assess the efficacy of bundle care for improving postoperative urinary control in patients receiving radical cystectomy and orthotopic ileal neobladder reconstruction. Methods Between January, 2014 and December, 2016, 60 patients with bladder cancer undergoing radical cystectomy and orthotopic ileal neobladder reconstruction in our department were randomly assigned into control group and bundle care group (n=30). In the control group, the patients were provided with routine instructions and training at discharge, and those in the bundle care group received additional interventions including training of the pelvic floor muscles and trainings for changing the manner of urination, increasing abdominal pressure by Valsalva breathing during urination, and keeping the voiding diary. The patients were followed up regularly and at 3, 6, and 12 months after the surgery, the urine dynamics, maximum and mean urinary flow rate, neobladder capacity and residual urine volume, renal functions and patient's satisfaction with urination were assessed and compared between the two groups. Results At 3, 6, and 12 months after the surgery, the patients in the bundle care group showed significantly greater maximum and mean urinary flow rate and neobladder capacity (P < 0.01) with smaller residual urine volume (P < 0.01) and better satisfaction with urination both in daytime and at night (P < 0.05) than those in the control group. Conclusion Bundle care interventions can effectively improve postoperative urinary control and promote functional recovery of the neobladder in patients receiving radical cystectomy and orthotopic ileal neobladder reconstruction for bladder cancer.

Keywords

• bundle care
• orthotopic ileal neobladder reconstruction
• bladder cancer
• urination function