Can we predict the need for clean intermittent catheterization after orthotopic neobladder construction?

Introduction: We aimed to identify peri-operative and pathologic characteristics that may predict the need for clean intermittent catheterization (CIC) following radical cystectomy (RC) with orthotopic neobladder (ONB) in order to improve patient counseling on choice of urinary diversion. Materials and Methods: Between July 2004 and February 2013, all patients who underwent RC with ONB were identified. Peri-operative clinical and pathological features were evaluated and correlated with patients reported need for CIC. The independent T-test was performed for continuous variables and Chi-square test was performed for categorical variables. Multivariate forward stepwise logistic regression analysis was used to identify variables that correlated with need for CIC after ONB. Results: During the study period, 114 patients underwent RC with ONB creation. On univariate analysis, patients with higher body mass index, younger age, and non-vaginal or non-nerve-sparing procedures were more likely to require catheterization for complete emptying. Multivariate analysis demonstrates that conservative surgery (nerve sparing in males or vaginal sparing in females) was associated with a significantly lower rate of requiring CIC (Odds Ratio [OR] 0.20, P < 0.01). Surprisingly, older age was also associated with a slightly lower, but statistically significant, rate of requiring CIC (OR 0.92,P < 0.01). Conclusions: When counseling patients regarding the different types of diversions after RC, the potential need for long-term CIC after ONB must be discussed. The clinical factors that appear to increase the need for CIC include non-conservative RC (non-nerve sparing in males and non-vaginal sparing in females) and, to a certain degree, younger age

Open doors and closed frontiers: the limits of American empire

This article argues that the contemporary American empire displays two structural limits. The first refers to geographical limits. As opposed to most of its imperial predecessors, the logic of contemporary US power militates against direct, territorial domination as a means of sustaining global hegemony. The second limitation, tightly linked to this first one, is that of power defined in a conventional sense as the capacity to secure outcomes. Consequently, since 1945 the USA has generally projected its global power through open doors (capitalist markets) and closed frontiers (sovereign territorial states). The article explores the peculiar limits to US empire with reference to two of its principal western precursors — the Roman and British empires — and concludes that the recent invasion and occupation of Iraq highlights the perils of an American strategy that seeks to conquer territories militarily and politically control their populations