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.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Supporting Information

References

1R. K. Lee, H. Abol-Enein, W. Artibani, et al., “Urinary Diversion After Radical Cystectomy for Bladder Cancer: Options, Patient Selection, and Outcomes,” BJU International 113, no. 1 (2014): 11–23, https://doi.org/10.1111/BJU.12121.
10.1111/bju.12121
PubMed Web of Science® Google Scholar
2M. A. Cerruto, C. D'Elia, S. Siracusano, et al., “Is Health-Related Quality of Life After Radical Cystectomy Using Validated Questionnaires Really Better in Patients With Ileal Orthotopic Neobladder Compared to Ileal Conduit: A Meta-Analysis of Retrospective Comparative Studies,” Current Urology 10, no. 2 (2017): 57–68, https://doi.org/10.1159/000447153.
10.1159/000447153
PubMed Google Scholar
3F. Liedberg, G. Ahlgren, G. Baseckas, et al., “Long-Term Functional Outcomes After Radical Cystectomy With Ileal Bladder Substitute: Does the Definition of Continence Matter?,” Scandinavian Journal of Urology 51, no. 1 (2017): 44–49, https://doi.org/10.1080/21681805.2016.1249943.
10.1080/21681805.2016.1249943
PubMed Google Scholar
4N. Pyrgidis, I. Sokolakis, G. Haltmair, and G. Hatzichristodoulou, “The Effect of Urinary Diversion on Renal Function After Cystectomy for Bladder Cancer: Comparison Between Ileal Conduit, Orthotopic Ileal Neobladder, and Heterotopic Ileocecal Pouch,” World Journal of Urology 40, no. 12 (2022): 3091–3097, https://doi.org/10.1007/S00345-022-04211-Z.
10.1007/S00345-022-04211-Z
CAS PubMed Web of Science® Google Scholar
5P. Piazza, C. A. Bravi, S. Puliatti, et al., “Assessing Pentafecta Achievement After Robot-Assisted Radical Cystectomy and Its Association With Surgical Experience: Results From a High-Volume Institution,” Urologic Oncology: Seminars and Original Investigations 40, no. 6 (2022): 272.e11–272.e20, https://doi.org/10.1016/j.urolonc.2022.01.001.
10.1016/j.urolonc.2022.01.001
PubMed Web of Science® Google Scholar
6A. Kretschmer, T. Grimm, A. Buchner, et al., “Prognostic Features for Objectively Defined Urinary Continence After Radical Cystectomy and Ileal Orthotopic Neobladder in a Contemporary Cohort,” Journal of Urology 197, no. 1 (2017): 210–215, https://doi.org/10.1016/J.JURO.2016.08.004.
10.1016/J.JURO.2016.08.004
PubMed Web of Science® Google Scholar
7T. Grimm, J. Grimm, A. Buchner, et al., “Health-Related Quality of Life After Radical Cystectomy and Ileal Orthotopic Neobladder: Effect of Detailed Continence Outcomes,” World Journal of Urology 37, no. 11 (2019): 2385–2392, https://doi.org/10.1007/S00345-019-02643-8.
10.1007/S00345-019-02643-8
PubMed Web of Science® Google Scholar
8A. Brassetti, G. Tuderti, U. Anceschi, et al., “Combined Reporting of Surgical Quality, Cancer Control and Functional Outcomes of Robot-Assisted Radical Cystectomy With Intracorporeal Orthotopic Neobladder Into a Novel Trifecta,” Minerva Urologica E Nefrologica 71, no. 6 (2019): 590–596, https://doi.org/10.23736/S0393-2249.19.03566-5.
10.23736/S0393-2249.19.03566-5
PubMed Web of Science® Google Scholar
9G. E. Cacciamani, M. Winter, L. G. Medina, et al., “Radical Cystectomy Pentafecta: A Proposal for Standardisation of Outcomes Reporting Following Robot-Assisted Radical Cystectomy,” BJU International 125, no. 1 (2020): 64–72, https://doi.org/10.1111/bju.14861.
10.1111/bju.14861
PubMed Web of Science® Google Scholar
10R. Mastroianni, G. Tuderti, M. Ferriero, et al, “Open Versus Robot-Assisted Radical Cystectomy: Pentafecta and Trifecta Achievement Comparison From a Randomised Controlled Trial,” BJU International 132, no. 6 (2023): 671–677, https://doi.org/10.1111/BJU.16134.
10.1111/bju.16134
PubMed Web of Science® Google Scholar
11U. Anceschi, F. Di Maida, R. S. Flammia, et al, “Robotic Intracorporeal Padua Ileal Neobladder vs. Florin Pouch: Comparison of Mid-Term Urodynamic and Functional Profiles,” Minerva Urology and Nephrology 74, no. 6 (2022): 825–827, https://doi.org/10.23736/S2724-6051.22.04884-4.
10.23736/S2724-6051.22.04884-4
PubMed Google Scholar
12E. Checcucci, M. Manfredi, M. Sica, et al., “Robot-Assisted-Radical-Cystectomy With Total Intracorporeal Y Neobladder: Analysis of Postoperative Complications and Functional Outcomes With Urodynamics Findings,” European Journal of Surgical Oncology 48, no. 3 (2022): 694–702, https://doi.org/10.1016/J.EJSO.2021.12.014.
10.1016/J.EJSO.2021.12.014
PubMed Web of Science® Google Scholar
13F. Di Maida, A. A. Grosso, G. Tasso, et al., “Robot Assisted Radical Cystectomy With Florence Robotic Intracorporeal Neobladder (FloRIN): Functional and Urodynamic Features Compared With a Contemporary Series of Open Vescica Ileale Padovana (VIP),” European Journal of Surgical Oncology 48, no. 8 (2022): 1854–1861, https://doi.org/10.1016/J.EJSO.2022.04.007.
10.1016/J.EJSO.2022.04.007
PubMed Web of Science® Google Scholar
14R. Satkunasivam, M. Santomauro, S. Chopra, et al., “Robotic Intracorporeal Orthotopic Neobladder: Urodynamic Outcomes, Urinary Function, and Health-Related Quality of Life,” European Urology 69, no. 2 (2016): 247–253, https://doi.org/10.1016/j.eururo.2015.06.041.
10.1016/j.eururo.2015.06.041
PubMed Web of Science® Google Scholar
15A. D. Asimakopoulos, M. Gubbiotti, E. F. Agrò, et al., “‘Bordeaux Neobladder’: First Evaluation of the Urodynamic Outcomes,” European Urology Open Science 47 (2023): 102–109, https://doi.org/10.1016/J.EUROS.2022.11.010.
10.1016/J.EUROS.2022.11.010
PubMed Web of Science® Google Scholar
16E. Grobet-Jeandin, D. Benamran, U. Pinar, et al., “Urodynamic Assessment and Quality of Life Outcomes of Robot-Assisted Totally Intracorporeal Radical Cystectomy and Orthotopic Neobladder for Bladder Cancer: A Preliminary Study,” World Journal of Urology 40, no. 10 (2022): 2535–2541, https://doi.org/10.1007/S00345-022-04126-9.
10.1007/S00345-022-04126-9
PubMed Web of Science® Google Scholar
17M. Ferriero, G. Simone, A. Rocchegiani, et al., “Early and Late Urodynamic Assessment of Padua Ileal Bladder,” Urology 73, no. 6 (2009): 1357–1362, https://doi.org/10.1016/j.urology.2009.01.053.
10.1016/j.urology.2009.01.053
PubMed Web of Science® Google Scholar
18A. Khan, J. Vuppalapati, L. Sarath, M. Mujeeburahiman, and N. D'souza, “Functional Outcome of Robotic-Assisted Intracorporeal Versus Extracorporeal Neobladder Following Radical Cystectomy: Initial Experience,” Urology Annals 13, no. 1 (2021): 9–13, https://doi.org/10.4103/UA.UA_132_19.
10.4103/UA.UA_132_19
PubMed Web of Science® Google Scholar
19F. C. Burkhard, T. M. Kessler, J. Springer, and U. E. Studer, “Early and Late Urodynamic Assessment of Ileal Orthotopic Bladder Substitutes Combined With an Afferent Tubular Segment,” Journal of Urology 175, no. 6 (2006): 2155–2161, https://doi.org/10.1016/S0022-5347(06)00278-3.
10.1016/S0022-5347(06)00278-3
PubMed Google Scholar
20G. Simone, R. Papalia, L. Misuraca, et al., “Robotic Intracorporeal Padua Ileal Bladder: Surgical Technique, Perioperative, Oncologic and Functional Outcomes,” European Urology 73, no. 6 (2018): 934–940, https://doi.org/10.1016/j.eururo.2016.10.018.
10.1016/j.eururo.2016.10.018
PubMed Web of Science® Google Scholar
21A. Minervini, F. Di Maida, G. Tasso, et al., “Robot Assisted Radical Cystectomy With Florence Robotic Intracorporeal Neobladder (FloRIN): Analysis of Survival and Functional Outcomes After First 100 Consecutive Patients Upon Accomplishment of Phase 3 IDEAL Framework,” European Journal of Surgical Oncology 47, no. 10 (2021): 2651–2657, https://doi.org/10.1016/j.ejso.2021.05.007.
10.1016/j.ejso.2021.05.007
PubMed Google Scholar
22M. J. Drake, S. K. Doumouchtsis, H. Hashim, and A. Gammie, “Fundamentals of Urodynamic Practice, Based on International Continence Society Good Urodynamic Practices Recommendations,” Neurourology and Urodynamics 37 (2018): S50–S60, https://doi.org/10.1002/nau.23773.
10.1002/nau.23773
PubMed Web of Science® Google Scholar
23A. Gammie, B. Clarkson, C. Constantinou, et al., “International Continence Society Guidelines on Urodynamic Equipment Performance,” Neurourology and Urodynamics 33, no. 4 (2014): 370–379, https://doi.org/10.1002/NAU.22546.
10.1002/nau.22546
CAS PubMed Web of Science® Google Scholar
24U. Anceschi, M. C. Ferriero, G. Tuderti, et al., “Head to Head Impact of Margin, Ischemia, Complications, Score Versus a Novel Trifecta Score on Oncologic and Functional Outcomes After Robotic-Assisted Partial Nephrectomy: Results of a Multicenter Series,” European Urology Focus 7 (2021): 1391–1399, https://doi.org/10.1016/j.euf.2020.06.021.
10.1016/j.euf.2020.06.021
PubMed Web of Science® Google Scholar
25E. Lavallee, J. Sfakianos, R. Mehrazin, and P. Wiklund, “Detailed Description of the Karolinska Technique for Intracorporeal Studer Neobladder Reconstruction,” Journal of Endourology 36 (2022): S67–S72, https://doi.org/10.1089/end.2022.0248.
10.1089/end.2022.0248
PubMed Web of Science® Google Scholar
26S. Chopra, A. L. de Castro Abreu, A. K. Berger, et al., “Evolution of Robot-Assisted Orthotopic Ileal Neobladder Formation: A Step-By-Step Update to the University of Southern California (USC) Technique,” BJU International 119, no. 1 (2017): 185–191, https://doi.org/10.1111/bju.13611.
10.1111/bju.13611
PubMed Web of Science® Google Scholar
27J. W. F. Catto, P. Khetrapal, F. Ricciardi, et al., “Effect of Robot-Assisted Radical Cystectomy With Intracorporeal Urinary Diversion Vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients With Bladder Cancer: A Randomized Clinical Trial,” Journal of the American Medical Association 327, no. 21 (2022): 2092–2103, https://doi.org/10.1001/jama.2022.7393.
10.1001/jama.2022.7393
PubMed Web of Science® Google Scholar
28R. Mastroianni, M. Ferriero, G. Tuderti, et al., “Open Radical Cystectomy Versus Robot-Assisted Radical Cystectomy With Intracorporeal Urinary Diversion: Early Outcomes of a Single-Center Randomized Controlled Trial,” Journal of Urology 207, no. 5 (2022): 982–992, https://doi.org/10.1097/JU.0000000000002422.
10.1097/JU.0000000000002422
PubMed Web of Science® Google Scholar
29W. D. Steers, “Voiding Dysfunction in the Orthotopic Neobladder,” World Journal of Urology 18, no. 5 (2000): 330–337, https://doi.org/10.1007/S003450000146.
10.1007/S003450000146
CAS PubMed Web of Science® Google Scholar
30U. Iqbal, M. M. Durrani, A. S. Elsayed, et al., “Functional Outcomes After Robot-Assisted Radical Cystectomy: A Review of Literature,” International Journal of Urology 28, no. 5 (2021): 493–501, https://doi.org/10.1111/IJU.14495.
10.1111/iju.14495
PubMed Web of Science® Google Scholar
31D. Mitropoulos, W. Artibani, M. Graefen, M. Remzi, M. Rouprêt, and M. Truss, “Reporting and Grading of Complications After Urologic Surgical Procedures: An Ad Hoc EAU Guidelines Panel Assessment and Recommendations,” European Urology 61, no. 2 (2012): 341–349, https://doi.org/10.1016/j.eururo.2011.10.033.
10.1016/j.eururo.2011.10.033
PubMed Web of Science® Google Scholar
32Z. Chen, G. Lu, X. Li, et al., “Better Compliance Contributes to Better Nocturnal Continence With Orthotopic Ileal Neobladder Than Ileocolonic Neobladder After Radical Cystectomy for Bladder Cancer,” Urology 73, no. 4 (2009): 838–843, https://doi.org/10.1016/J.UROLOGY.2008.09.076.
10.1016/J.UROLOGY.2008.09.076
PubMed Web of Science® Google Scholar
33E. J. McGuire, R. D. Cespedes, and H. E. O'Connell, “Leak-Point Pressures,” Urologic Clinics of North America 23, no. 2 (1996): 253–262, https://doi.org/10.1016/S0094-0143(05)70309-8.
10.1016/S0094-0143(05)70309-8
CAS PubMed Web of Science® Google Scholar
34E. Finazzi Agrò, D. Bianchi, and V. Iacovelli, “Pitfalls in Urodynamics,” European Urology Focus 6, no. 5 (2020): 820–822, https://doi.org/10.1016/j.euf.2020.01.005.
10.1016/j.euf.2020.01.005
PubMed Google Scholar

Volume44, Issue6

August 2025

Pages 1255-1263

Filename	Description
nau70078-sup-0001-Supplementary_Table_1.docx22.6 KB	Supplementary Table 1.
nau70078-sup-0002-Supplementary_Table_2.docx30.3 KB	Supplementary Table 2.

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

ABSTRACT

Introduction

Materials & Methods

Results

Conclusion

Clinical Trial Registration

Conflicts of Interest

Open Research

Data Availability Statement

Supporting Information

References

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

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

ABSTRACT

Introduction

Materials & Methods

Results

Conclusion

Clinical Trial Registration

Conflicts of Interest

Open Research

Data Availability Statement

Supporting Information

References

References

Related

Information