Long-term functional outcomes after radical cystectomy with ileal bladder substitute: does the definition of continence matter?

OBJECTIVE: Functional outcomes after ileal bladder substitution reflect the expectations of future patients at a particular centre. The aim of this study was to use validated questionnaires and a pad-weighing test to investigate functional outcomes after neobladder reconstruction at long-term follow-up in patients at a single centre. MATERIALS AND METHODS: During 2005 - 2015, 75 patients received a Studer ileal bladder substitute at the Department of Urology, Malmö. Forty-six of these patients were alive for follow-up and were evaluated using the pad-weighing test and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). RESULTS: Five of 37 evaluable patients (14%) were considered fully continent, reporting a pad-weighing test result of 0 g and an ICIQ-UI-SF score of 0. The median ICIQ-UI-SF score was 8 [interquartile range (IQR) 3-11], and seven patients (17%) were continent according to the ICIQ-UI-SF score only. In the pad-weighing test, 28 out of 37 patients (76%) reported 0 g day-time leakage whereas only 12 out of 37 patients (32%) reported 0 g night-time leakage. At follow-up, nine out of 39 (23%) of evaluable male patients were potent. The median ICIQ-UI-SF score was significantly lower during the second half of the study period [4 (IQR 0-8) vs 10 (IQR 6-14); p = .003]. The inverse applied to the median IIEF score [5 (IQR 3-12) vs 2 (IQR 1-4); p = .02]. CONCLUSIONS: Functional outcomes at long-term follow-up after radical cystectomy and Studer ileal bladder substitute were at best modest in this series. Better outcomes during the second half of the study period might be explained by improved patient selection and a refined surgical technique, but possibly also by longer follow-up of patients during the first half of the period resulting in a more pronounced time-dependent decline in functional outcomes.

Variability in glycosylated hemoglobin values in diabetic patients living in long-term care facilities.

OBJECTIVES: The objectives of this study were to determine the prevalence of diabetes and mean A1C of patients in long-term care facilities (LTCFs); to determine differences in A1C values based on patient characteristics; and to examine the self-reported practices of providers regarding diabetes management goals. DESIGN: Twelve-month retrospective review of patient charts; survey of physicians and nurse practitioners providing care to these patients. SETTING: Nursing facility practice of an urban teaching hospital. PARTICIPANTS: Participants included 168 diabetic patients living in 20 nursing facilities and 18 physician and nurse practitioners in one practice providing care to these patients. RESULTS: The prevalence of diabetes was 21.6% (168 of 778 patients). Mean A1C was 7.1% +/- 1.2%for 135 patients who had AIC values measured during the study interval. A1C varied by age, with patients younger than 65 having higher A1C values than patients older than 65. Higher A1C values were associated with insulin use, frequent glucose monitoring, and attending a diabetes clinic. Although a survey of providers identified modifying A1C target ranges for LTCF compared with ambulatory patients, they did not reach consensus on the actual target A1C. No association between provider perception of either patient health status or patient life expectancy and A1C values was found. CONCLUSIONS: Relatively low A1C values were obtainable in LTCF patients without diabetes specialty clinic use. Providers identified modifying target A1C values for LTCF patients, but achieved relatively low A1C values and did not agree on a target A1C value for LTCF patients.