Clean Intermittent Catheterization After Orthotopic Neobladder
The requirement for clean intermittent catheterization (CIC) after orthotopic neobladder is common, occurring in approximately 45% of female patients and 4-10% of male patients, with significant gender disparity being the most important predictor. 1
Gender-Specific CIC Rates
Female Patients
- CIC is required in almost 45% of women following orthotopic neobladder reconstruction 1
- In one Canadian cohort, 59% of women performed CIC at 12 months post-surgery 2
- Four out of 8 women (50%) required CIC in a long-term follow-up study, potentially due to hypercontinence from downward neobladder migration and reduced voiding pressures 3
Male Patients
- CIC is required in only 3.9-9.5% of male patients 4, 5
- The vast majority (96.1%) of men void spontaneously without catheterization 4
- Only 1.7% require regular intermittent catheterization 4
Timing of CIC Initiation
- When CIC is needed, 70.6% of patients start within the first postoperative year 5
- This indicates that emptying dysfunction typically manifests early rather than as a late complication 5
International Practice Patterns
- A national survey in India reported highly variable CIC rates ranging from 10-100%, with an average of 50% of neobladder patients requiring intermittent catheterization 6
- This wide variation likely reflects differences in patient selection, surgical technique, and postoperative management protocols 6
Clinical Implications
The dramatic gender difference in CIC requirements (45% in women vs 4-10% in men) must be explicitly discussed during preoperative counseling. 1, 2 Women considering orthotopic neobladder should understand they have nearly a 50% chance of requiring lifelong CIC, which demands manual dexterity, motivation, and commitment to the technique.
Risk Factors for CIC Requirement
- Female gender is the strongest predictor 1, 2
- Increasing age predicts worse urinary function but does not specifically predict CIC need 5
- Diabetes mellitus predicts worse urinary function but not CIC requirement 5
Common Pitfall
The most critical error is failing to adequately counsel female patients about the high likelihood (approximately 45%) of requiring CIC before proceeding with orthotopic neobladder. 1 This information is essential for informed decision-making between neobladder and ileal conduit diversion, as patients unable or unwilling to perform CIC should not undergo neobladder reconstruction. 7