Do You Take Vitamin B12 Supplementary Medication?

TübingenNeobladder Questionnaire

1. Do you take Vitamin B12 supplementary medication?

a. Yes

b. No

1. Do you take bicarbonate supplementary medication ?

1. Yes
2. No

1. How many urinary tract infections (UTI) did you experience during the last year?

a. 0

b. 1

c. 2

d. 3

e. 4

f. >4

3.1. If yes, how many were feverish?

a. 1

b. 2

c. 3

d. 4

e. >4

4. How high is your measured mean micturition volume (please use measuring container) ?

a. <100ml

b.100-200ml

c.200-300ml

d.300-400ml

e.400-500ml

f.>500ml

5. Do you void with additional abdominal straining to empty your neobladder?

a. yes

b. no

6. Do you perform intermittent self-catheterization to empty your neobladder?

a. yes

b. no

6.1. If yes, how often do you perform self-catheterization within 24hours?

Frequency per daytime (12 hours) ...... (No. of catheters used)

Frequency per nighttime (12 hours)...... (No. of catheters used)

Catheter volume per daytime...... (in mL)

Catheter volume per nighttime...... (in mL)

7. Do you feel flank-sided pain during voiding?

a. yes

b. no

8. Do you use pads for urinary incontinence during daytime?

a. yesif yes, how many pads ......

b. no

8.1. Are these pads humid or wet during the day?

a. humid

b. wet

8.2If you lose urine into your pad during daytime, how heavy (in gramm [g]) are these pads when you measure their weight in the evening (Please compare the weight of a dry one versus a damp versus a wet pad)?

Dry: ...... g.Humid: ...... g.Wet: ...... g.

8.3 For male patients: Do you use a condom catheter during daytime?

a. yes

b. no

9. Do you use pads only for safety reasons?

9.1 During daytime

a. yes

b.no

9.2During nighttime

a. yes

b.no

10. Do you use pads for urinary incontinence during nighttime?

a.yesif yes, how many pads......

b. no

10.1 Are these pads humid or wet during the night?

a. humid

b. wet

10.2 If you lose urine into your pad during the night, how heavy (in gramm, [g])are these pads when you measure their weight in the morning (Compare a damp or wet pad to a dry one)?

Dry: ...... g.Humid: ...... g.Wet: ...... g.

10.3 For male patients: Do you use condom catheters during nighttime?

a. yes

b. no

11. Do you notice mucus in your neobladder urine (“slimy” urine).

a. yes

b. no

12. For male patients: Do you currently use medication to gain or maintain an erection after cystectomy (f.e.: Viagra®, Cialis®)?

a. yes

b. no

12.1 For male patients: Have you ever used medication on a regular basis to gain or maintain an erection (i.e.: Viagra®, Cialis®) before cystectomy?

a. yes

b. no