Health-related quality of life after radical cystectomy for bladder cancer in elderly patients with an ileal conduit, ureterocutaneostomy, or orthotopic urinary reservoir: a comparative questionnaire survey.

Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Acta medica Okayama (Impact Factor: 0.65). 09/2007; 61(4):199-203.
Source: PubMed

ABSTRACT To compare the health-related quality of life of elderly patients after radical cystectomy for bladder cancer in urinary diversion groups: ileal conduit, ureterocutaneostomy, or orthotopic urinary reservoir. The 109 participating elderly patients aged 75 or older completed self-reporting questionnaires: the QLQ-C30, and on satisfaction with urinary diversion methods. Fifty-six patients had undergone constructions for ileal conduit diversion, 31 for ureterocutaneostomy, and 22 for orthotopic urinary reservoir (OUR). The median follow-up period for each group was 4.0 years (range 0.3-11.2), 4.5 years (range 0.3-18.0), and 3.3 years (range 0.3-6.7), respectively. Regardless of the type of urinary diversion, the majority of patients reported having good overall quality of life, although with some problem of pain. No significant differences among urinary diversion subgroups were found in any quality of life area in the QLQ-C30 questionnaire. More patients in the OUR sub-group felt disappointment than those in the ileal conduit or cutaneostomy sub-groups. However, a questionnaire which asked which diversion method would be preferable showed a trend that more patients in the OUR subgroup would have chosen the same one. Health-related quality of life appeared relatively good in these 3 groups. Patient demands and expectations may be so different from the results that the details of each urinary diversion method should be explained thoroughly. OUR construction could be a candidate even for elderly patients.

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    ABSTRACT: Aufgrund des demographischen Wandels wird die Inzidenz von Blasenkarzinomen zunehmen. Bei muskelinvasiven Tumoren ist die radikale Zystektomie durch Fortschritte im perioperativen Management auch beim älteren Patienten indiziert. Durch die ebenfalls altersabhängige Zunahme von Komorbiditäten stellt sich die Frage nach der optimalen Harnableitung für den Risikopatienten. Das Ileumconduit stellt dazu aufgrund seiner sicheren, erprobten und risikoarmen Anwendung den Goldstandard dar. Aufgrund der Darmbeteiligung weist es jedoch relevante Komplikationsrisiken für den Risikopatienten auf. Eine noch einfachere und sichere Alternative stellt die Harnleiterhautfistel dar, die jedoch zunächst hohe Stenosierungsraten aufwies. Neuere Daten weisen allerdings darauf hin, dass vergleichbar viele Patienten ohne Harnleiterstent auskommen wie beim Ileumconduit. Auch Untersuchungen zur Lebensqualität zeigen vergleichbare Ergebnisse. Aus diesem Grund sollte die häufig zurückhaltende Einstellung gegenüber der Harnleiterhautfistel bei Risikopatienten überdacht werden.
    Der Urologe 09/2012; 51(9). · 0.46 Impact Factor
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    ABSTRACT: BACKGROUND: Robot-assisted radical cystectomy (RARC) with totally intracorporeal neobladder diversion is a complex procedure that has been reported with good outcomes in small series. OBJECTIVE: To present complications and oncologic and functional outcomes of this procedure. DESIGN, SETTING, AND PARTICIPANTS: Between 2003 and 2012 in a tertiary referral center, 70 patients were operated on by two experienced robotic surgeons. Data were collected prospectively and reviewed retrospectively. INTERVENTION: RARC with totally intracorporeal modified Studer ileal neobladder formation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The overall outcome of RARC with a totally intracorporeal neobladder was presented by assessing (1) surgical margins, (2) recurrence or cancer-specific death at 24 mo, (3) 30-d and 90-d complications graded according to the modified Clavien-Dindo system, (4) daytime and nighttime continence (no or one pad per day) at 6 and 12 mo, and (5) satisfactory sexual activity or potency at 6 mo and 12 mo. Survival rates were estimated by Kaplan-Meier plots. RESULTS AND LIMITATIONS: Median follow-up of the cohort was 30.3 mo (interquartile range: 12.7-35.6). We recorded negative margins in 69 of 70 patients (98.6%). Clavien 3-5 complications occurred in 22 of 70 patients (31.4%) at 30 d and 13 of 70 (18.6%) at >30 d. At 90 d, the overall complication rate was 58.5%. Clavien <3 and Clavien ≥3 complications were recorded in 15 of 70 patients (21.4%) and 26 of 70 (37.1%), respectively. Kaplan-Meier estimates for recurrence-free, cancer-specific, and overall survival at 24 mo were 80.7%, 88.9%, and 88.9%, respectively. Daytime continence and satisfactory sexual function or potency at 12 mo ranged between 70% and 90% in both men and women. Limitations of this study include its retrospective design, selection bias due to the learning curve phase, and missing data. CONCLUSIONS: In this expert center for RARC, outcomes after RARC with totally intracorporeal neobladder diversion appear satisfactory and in line with contemporary open series.
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