A Novel Scoring System to Assess Continence Quality Outcomes of Orthotopic Ileal Neobladders After Open and Robot-Assisted Radical Cystectomy: The Urodynamic Trifecta

Introduction: 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 cmH₂0; 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. Results: 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. Conclusion: 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. Clinical Trial Registration: Not applicable.